Wu Kai, Liao Min, Deng Juan, Yu Yunfeng, Yin Yuman, Yang Xinyu, Yu Rong, Liu Zhenjie
Department of Gastroenterology, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China.
Department of Anesthesiology, People's Hospital of Ningxiang City, Changsha, Hunan, China.
Front Pharmacol. 2025 Aug 15;16:1592781. doi: 10.3389/fphar.2025.1592781. eCollection 2025.
The potential of ciprofol in endoscopic anesthesia is receiving increasing attention. Compared to propofol, ciprofol exhibits stronger sedative effects and requires a lower dosage. This study aimed to compare the safety of ciprofol and propofol in Chinese patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) anesthesia.
A comprehensive literature search was conducted across eight common databases before 1 January 2025, including PubMed, Embase, the Cochrane Library, and Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, and SinoMed. After screening the literature according to established standards, the meta-analysis and trial sequential analysis (TSA) were conducted using Review Manager 5.3 and TSA 0.9.5.10 beta, respectively. Finally, publication bias for each outcome was assessed using Harbord regression analysis.
Seven randomized controlled trials (RCTs) with 1,264 participants undergoing ERCP were included, and all included studies were conducted in China, with participants representing the Chinese population. The meta-analysis showed that compared to propofol, ciprofol reduced bradycardia (risk ratio [RR] 0.44, 95% confidence interval [CI] 0.26-0.76, P = 0.003, n = 4), hypotension (RR 0.72, 95% CI 0.55-0.95, P = 0.02, n = 4), respiratory depression (RR 0.25, 95% CI 0.14-0.44, P < 0.00001, n = 5), hypoxemia (RR 0.35, 95% CI 0.21-0.58, P < 0.0001, n = 5), and injection pain (RR 0.17, 95% CI 0.11-0.26, P < 0.00001, n = 7), but had no significant effect on choking cough, involuntary movements, or nausea and vomiting. TSA showed a conclusive benefit for bradycardia, respiratory depression, hypoxemia, and injection pain, whereas the benefit for hypotension needs further validation. Harbord regression analysis showed no publication bias for any of the outcomes, except for hypotension.
Compared with propofol, ciprofol has been shown to reduce the incidence of bradycardia, respiratory depression, hypoxemia, and injection pain in patients undergoing ERCP; however, its effect on the occurrence of hypotension still requires further investigation. Future studies are warranted to clarify the safety, efficacy, and optimal dosing of ciprofol across various patient populations, particularly those with complex comorbidities. These efforts would facilitate the broader application of ciprofol in ERCP and other surgical procedures, such as gastrointestinal and ophthalmic surgeries.
www.crd.york.ac.uk/PROSPERO/view/CRD420251090047, identifer, CRD420251090047.
环泊酚在内镜麻醉中的潜力正受到越来越多的关注。与丙泊酚相比，环泊酚具有更强的镇静作用且所需剂量更低。本研究旨在比较环泊酚和丙泊酚在中国接受内镜逆行胰胆管造影（ERCP）麻醉患者中的安全性。
在2025年1月1日前，对八个常见数据库进行了全面的文献检索，包括PubMed、Embase、Cochrane图书馆、Web of Science、中国知网、中国科技期刊数据库、万方和中国生物医学文献数据库。按照既定标准筛选文献后，分别使用RevMan 5.3和TSA 0.9.5.10 beta进行荟萃分析和试验序贯分析（TSA）。最后，使用Harbord回归分析评估每个结局的发表偏倚。
纳入了7项随机对照试验（RCT），共1264例接受ERCP的参与者，所有纳入研究均在中国进行，参与者代表中国人群。荟萃分析表明，与丙泊酚相比，环泊酚可降低心动过缓（风险比[RR] 0.44，95%置信区间[CI] 0.26 - 0.76，P = 0.003，n = 4）、低血压（RR 0.72，95% CI 0.55 - 0.95，P = 0.02，n = 4）、呼吸抑制（RR 0.25，95% CI 0.14 - 0.44，P < 0.00001，n = 5）、低氧血症（RR 0.35，95% CI 0.21 - 0.58，P < 0.0001，n = 5）和注射痛（RR 0.17，95% CI 0.11 - 0.26，P < 0.00001，n = 7）的发生率，但对呛咳、不自主运动或恶心呕吐无显著影响。TSA显示，环泊酚对心动过缓、呼吸抑制、低氧血症和注射痛有确切益处，而对低血压的益处需要进一步验证。Harbord回归分析显示，除低血压外，其他结局均无发表偏倚。
与丙泊酚相比，环泊酚已被证明可降低接受ERCP患者的心动过缓、呼吸抑制、低氧血症和注射痛的发生率；然而，其对低血压发生的影响仍需进一步研究。未来有必要开展研究，以阐明环泊酚在不同患者群体，特别是合并复杂疾病患者中的安全性、有效性和最佳剂量。这些努力将有助于环泊酚在ERCP及其他外科手术，如胃肠手术和眼科手术中更广泛的应用。
www.crd.york.ac.uk/PROSPERO/view/CRD420251090047，标识符，CRD420251090047。
