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.