Introduction
General anesthesia is a cornerstone of modern medical practice, designed
to achieve the vital goals of amnesia, unconsciousness (hypnosis), and
immobilization during surgical procedures. These objectives are met
through the use of general anesthetics, which exhibit the remarkable
ability to reversibly induce these therapeutic effects [1,2]. Among
the diverse classes of anesthetic agents, both volatile and intravenous
anesthetics play pivotal roles in ensuring reliable and effective
anesthesia.
Propofol, a potent γ-aminobutyric acid (GABA) receptor agonist, stands
as a testament to the success of intravenous anesthetics over the past
three decades [3,4]. Its favorable pharmacokinetic (PK) and
pharmacodynamic (PD) properties have propelled it to the forefront of
anesthesia practice. Known for its rapid and consistent induction,
minimal excitation phenomena, short context-sensitive time, rapid
terminal half-life, and low incidence of postoperative nausea and
vomiting, propofol has become a cornerstone of anesthesia induction and
maintenance [3]. Nevertheless, even with its exceptional attributes,
propofol is not without limitations, which include injection pain,
hypotension, respiratory depression leading to apnea, and the potential
for the development of intensive care unit (ICU) syndrome [5-7]. It
continues to serve as the gold standard against which newer agents are
benchmarked, one of these agents being ciprofol (HSK3486).
In recent years, the field of anesthesiology has experienced a surge in
the exploration of novel agents for both induction and maintenance of
general anesthesia. Among these, ciprofol has emerged as a promising
contender, boasting claims of enhanced safety and efficacy when compared
to traditional agents. First reported in 2017, ciprofol represents a
structural analog of propofol, incorporating an R-chiral center and a
cyclopropyl group that imparts improved pharmacological and
physicochemical properties. These enhancements render ciprofol more
potent than propofol and, notably, less painful upon injection
[8,9]. A phase 1 trial demonstrated the safety of ciprofol at doses
ranging from 0.15 to 0.90 mg/kg, with most adverse events being of mild
to moderate intensity [10]. Given its increased potency relative to
propofol, ciprofol necessitates a lower drug volume for achieving
anesthesia, which not only reduces the required solvent volume but may
also mitigate side effects, particularly those associated with injection
site pain.
The primary objective of this comprehensive meta-analysis is to
systematically review and synthesize the existing body of literature
pertaining to the safety and efficacy of ciprofol compared to propofol
in the context of induction and maintenance of general anesthesia in
adult patients undergoing surgical procedures. Through the amalgamation
of data from multiple studies, we aspire to offer an extensive
evaluation of the relative merits of these two agents. By doing so, we
aim to provide valuable insights for both researchers and clinicians in
the field of anesthesiology, ultimately contributing to the enhancement
of anesthesia practices and patient care.