Comparative effects of ciprofol and propofol on perioperative outcomes: a systematic review and meta-analysis of randomized controlled trials
Efeitos comparativos de ciprofol e propofol nos resultados perioperatórios: uma revisão sistemática e meta-análise de ensaios clínicos randomizados
Jiazheng Qi, Lingjing Zhang, Fanhua Meng, Xiaoyu Yang, Baoxuan Chen, Lingqi Gao, Xu Zhao, Mengqiang Luo
Abstract
Background
The ideal anesthetic agents for sedation, considering their respiratory and cardiovascular benefits and other perioperative or postoperative outcomes, are still unclear. This systematic review and meta-analysis aimed to evaluate whether ciprofol has advantages over propofol for sedation, particularly concerning respiratory and cardiovascular outcomes and other relevant perioperative measures.
Methods
We conducted a comprehensive search of PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and two Chinese databases for randomized controlled trials comparing intravenous ciprofol and propofol for sedation. The primary outcome was the incidence of adverse respiratory events. Secondary outcomes included incidences of injection pain, hypotension, hypertension, bradycardia during surgery, perioperative nausea and vomiting, and postoperative awakening time. A random-effects model was used for more than four studies; otherwise, we employed the random-effects model with the Hartung-Knapp-Sidik-Jonkman adjustment.
Results
Intravenous ciprofol resulted in fewer adverse respiratory events than propofol (Risk Ratio [RR = 0.44]; 95% Confidence Interval [95% CI 0.35–0.55], p < 0.001, I2 = 45%, low quality). It also showed a lower incidence of injection pain (RR = 0.12; 95% CI 0.08‒0.17, p < 0.001, I2 = 36%, low quality), intraoperative hypotension (RR = 0.64; 95% CI 0.52–0.77, p < 0.001, I2 = 58%, low quality), and nausea and vomiting than propofol (RR = 0.67; 95% CI 0.49–0.92; p = 0.01, I2 = 0%, moderate quality). However, no significant differences were observed for hypertension, bradycardia, and awakening time.
Conclusions
Ciprofol may be more effective than propofol in minimizing perioperative respiratory adverse events and maintaining hemodynamic stability during sedation without prolonging recovery time.
Keywords
Resumo
Introdução
Os agentes anestésicos ideais para sedação, considerando seus benefícios respiratórios e cardiovasculares e outros resultados perioperatórios ou pós-operatórios, ainda não estão claros. Esta revisão sistemática e meta-análise teve como objetivo avaliar se o ciprofol tem vantagens sobre o propofol para sedação, particularmente em relação aos resultados respiratórios e cardiovasculares e outras medidas perioperatórias relevantes.
Métodos
Realizamos uma busca abrangente no PubMed, Web of Science, Cochrane Central Register of Controlled Trials e em dois bancos de dados chineses para ensaios clínicos randomizados comparando ciprofol intravenoso e propofol para sedação. O resultado primário foi a incidência de eventos respiratórios adversos. Os resultados secundários incluíram incidências de dor à injeção, hipotensão, hipertensão, bradicardia durante a cirurgia, náusea e vômito perioperatórios e tempo de despertar pós-operatório. Um modelo de efeitos aleatórios foi usado para mais de quatro estudos; caso contrário, empregamos o modelo de efeitos aleatórios com o ajuste de Hartung-Knapp-Sidik-Jonkman.
Resultados
O ciprofol intravenoso resultou em menos eventos respiratórios adversos do que o propofol (razão de risco [RR = 0,44]; intervalo de confiança de 95% [IC de 95% 0,35–0,55], p < 0,001, I2 = 45%, baixa qualidade). Também mostrou menor incidência de dor à injeção (RR = 0,12; IC de 95% 0,08‒0,17, p < 0,001, I2 = 36%, baixa qualidade), hipotensão intraoperatória (RR = 0,64; IC de 95% 0,52–0,77, p < 0,001, I2 = 58%, baixa qualidade) e náusea e vômito do que o propofol (RR = 0,67; IC de 95% 0,49–0,92; p = 0,01, I2 = 0%, qualidade moderada). Entretanto, não foram observadas diferenças significativas para hipertensão, bradicardia e tempo de despertar.
Conclusão
O ciprofol pode ser mais eficaz do que o propofol na minimização de eventos adversos respiratórios perioperatórios e na manutenção da estabilidade hemodinâmica durante a sedação sem prolongar o tempo de recuperação.
Palavras-chave
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Submitted date:
07/03/2024
Accepted date:
11/09/2024
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