Efficacy and safety of ciprofol versus propofol for sedation in hysteroscopy: a systematic review and meta-analysis.

Abstract

<h4>Background</h4>Hysteroscopy, a popular outpatient gynecological procedure, often requires sedation due to pain caused by endometrial manipulation and cervical dilation. Propofol, the current standard sedative, has adverse effects like respiratory depression, hypotension, and injection discomfort. Ciprofol, a novel GABA-A receptor agonist and structural analog of propofol, might be a safer choice while maintaining efficacy.<h4>Objectives</h4>This systematic review and meta-analysis aims to compare the efficacy and safety of ciprofol versus propofol for sedation during hysteroscopy.<h4>Design</h4>A systematic review and meta-analysis of randomized controlled trials (RCTs).<h4>Data sources and methods</h4>This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RCTs comparing ciprofol and propofol for hysteroscopic sedation were sourced from PubMed, Cochrane, Scopus, Google Scholar, and ClinicalTrials.gov. Data extraction, quality assessment (ROB-2), and analysis were conducted independently. Outcomes included efficacy, safety, and recovery metrics.<h4>Results</h4>Six RCTs with 1890 patients were met with inclusion. Ciprofol achieved similar sedative success as propofol (risk ratio (RR) = 1.00, 95% CI: 1.00-1.00) and surpassed propofol in important safety outcomes. It significantly reduced intraoperative body movements (RR = 0.53), injection pain (RR = 0.13), hypotension (RR = 0.58), and respiratory depression (RR = 0.67), while increasing eyelash reflex suppression (MD = 0.24). Ciprofol was also associated with a slightly longer recovery time compared to propofol (MD = 0.80 min). Bradycardia incidence and procedure duration did not differ significantly.<h4>Conclusion</h4>Ciprofol displays a better safety profile, including enhanced hemodynamic and respiratory stability and decreased injection discomfort, and is just as effective as propofol for sedation during hysteroscopy. According to these results, ciprofol is a safe alternative to propofol for hysteroscopy. It is advised that further multicenter studies are required to confirm its effectiveness across broader populations.<h4>Trial registration</h4>The meta-analysis has been registered with PROSPERO. The registration number is CRD420251091116.