Discussion
The influence of anesthesiologists’ satisfaction is pivotal in selecting anesthetic agents. Their trust in a drug’s effectiveness and safety profoundly impacts patient care. Our meta-analysis hints at a slightly stronger preference for Ciprofol, particularly during the induction phase. It’s essential to note, though, that these preferences don’t quite reach the threshold of statistical significance thus emphasizing that ciprofol and propofol exhibit similar satisfaction levels among anesthesiologists during both induction and maintenance phases of anesthesia. This aligns with existing literature, suggesting that Ciprofol could be a compelling alternative to Propofol in clinical anesthesia. [19] These consistent results strengthen the evidence that ciprofol can be a viable alternative to propofol in anesthesia practice, offering similar satisfaction levels for anesthesiologists while providing potential benefits such as safety and effectiveness [20,21] However, the absence of statistical significance highlights the multifaceted nature of this preference. Various factors, including individual preferences, patient-specific characteristics, surgical requirements, and the collective experiences of the anesthesia team, all play a role in shaping satisfaction levels. Furthermore, variations in satisfaction at different phases of anesthesia administration emphasize the need for tailored approaches to match the unique demands of each surgical step, ensuring the best possible patient outcomes and overall satisfaction [22]
Interestingly, we observed no statistically significant difference between both drugs for alertness. However, our results are inconsistent with existing literature on the subject. For instance, a recent systematic review [19] in the context of painless gastroenteroscopy found that Propofol consistently leads to faster alertness compared to Ciprofol. This inconsistency in results could be attributed to the fact that our study exclusively focused on invasive surgeries, which encompassed a diversity of surgical types. Propofol is well-known for its characteristics of rapid onset and swift recovery, which results from its pharmacokinetic property of fast elimination. [3,23] Thus making it a promising option to induce and maintain anesthesia, particularly for short-duration procedures. The rapid elimination of propofol minimizes the risk of residual sedation, promoting patient safety and reducing the need for extended post-anesthesia monitoring.[24] Anesthesiologists value Propofol for its ability to induce and reverse anesthesia swiftly, providing a significant advantage in various clinical scenarios. However, it’s crucial to recognize that this advantage comes with the caveat of a relatively narrow therapeutic window and potential concentration-dependent effects on cardiovascular and respiratory systems, especially in elderly and frail patients [9] These considerations underscore the importance of a nuanced approach when selecting anesthetic agents, taking into account the specific characteristics and vulnerabilities of the patient population.
Propofol’s superior induction speed, consistent with previous research, highlights its status as the preferred choice for anesthesia induction in clinical practice [19]. The absence of a substantial difference in induction time between Ciprofol at 0.4 mg and Propofol is an intriguing finding. It suggests that, at this lower dosage, Ciprofol can achieve induction times similar to Propofol [15]. This implies that Propofol may have a slightly faster onset of action for inducing anesthesia than Ciprofol [19], which could be advantageous in specific clinical scenarios. Heterogeneity is observed in Wang X’s study for several reasons. Firstly, Wang X conducted a phase 3, multicenter, randomized, double-blind, comparative study, which introduced differences in study design, data collection, and interpretation compared to studies in the same analysis. Additionally, the study had a larger sample size with a higher percentage of male patients, potentially introducing gender-related variations in anesthesia induction times. Furthermore, variations in patient age, BMI, and ASA score distribution in Wang X’s study could impact how individuals respond to anesthesia, leading to differences in induction times.
Contrary to the above-mentioned findings, our focus on the loss of eyelash reflex specifically revealed no divergences between the two agents. However, it is essential to acknowledge the presence of pronounced heterogeneity in our analysis of time to loss of eye reflex, which suggests substantial variability among the included studies. This heterogeneity, coupled with the limitation of limited data availability resulted in a trend not favoring either of the drugs, especially propofol.
Our meta-analysis provides valuable insights, affirming that both Ciprofol and Propofol can effectively serve for anesthesia induction and maintenance, with no significant differences observed. This conclusion gains strength through our subgroup analysis, which demonstrates that even with different Ciprofol dosages (0.4mg and 0.5mg), there are no significant differences in the success rate of anesthesia induction compared to Propofol. This suggests that the choice of Ciprofol dosage doesn’t significantly affect induction success rates [25]. These findings hold practical implications for anesthesiologists, indicating that both Ciprofol and Propofol are valid choices for anesthesia induction and maintenance. Clinicians can make their choices based on patient-specific factors and individual preferences.
The observation of a faster exit from the Post-Anesthesia Care Unit (PACU) and improved recovery of respiratory functions with Propofol aligns with its established characteristics of rapid onset and short duration of action. This can be attributed to Propofol’s favorable pharmacokinetic profile. However, the absence of statistical significance in these findings could be due to inherent variability in patient responses and the specific criteria used for assessment [26]. Nevertheless, these findings have significant clinical relevance, as quicker recovery and discharge from the PACU can enhance patient throughput and optimize resource utilization [27].
Managing pain at the injection site, a factor that can induce anxiety and discomfort among patients during intravenous (IV) infusion, is a critical consideration. Propofol has been known to cause pain at the injection site. [28] To address this concern, pretreatment with local anesthetics like lidocaine before IV administration of Propofol has been employed. Additionally, using a more diluted dose of Propofol has been explored to alleviate pain at the injection site [29]. In support of the current literature, our meta-analysis collectively shows that Ciprofol is less likely to cause pain at the injection site. This can be explained by the hydrophobic nature of Ciprofol, resulting in relatively lower plasma concentrations compared to Propofol [30].
In our comprehensive meta-analysis comparing ciprofol and propofol in the context of anesthesia, we conducted a thorough evaluation of various adverse events to assess the safety profiles of these two agents. Our findings indicate that, in general, there was no statistically significant difference observed between ciprofol and propofol in terms of overall adverse events. This suggests that both agents are generally well-tolerated and safe for use in anesthesia induction. Comparing our results to the existing literature, studies have reported varying safety profiles for both ciprofol and propofol. Some have highlighted the safety and effectiveness of ciprofol in anesthesia induction, with a lower incidence of adverse events.[25] In contrast, others have noted that propofol remains a standard and safe choice for anesthesia induction. [31]
Our study does have its limitations. We only included double-arm randomized control trials, limiting our dataset to six studies. Additionally, our study exclusively focused on invasive surgeries, which encompassed a diversity of surgical types. Though most studies affirm the safety of both drugs for clinical practice, it is worth noting that the existing literature on the comparison between these two drugs is relatively limited. Looking ahead, future research should delve into optimized Ciprofol dosing strategies aimed at achieving the desired depth of anesthesia while minimizing side effects [32]. Exploring patient-centered outcomes and integrating advanced monitoring technologies could also provide deeper insights into the comparative strengths and weaknesses of these agents. Large-scale studies spanning diverse patient groups and clinical scenarios, including specific procedures like gastrointestinal sedation, can shed light on the advantages concerning patient comfort and recovery. [33] Moreover, investigating long-term outcomes and cost-effectiveness can offer valuable guidance for clinical decision-making.