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.