A systematic review and meta-analysis comparing the efficacy and safety of ciprofol (HSK3486) versus propofol for anesthetic induction and non-ICU sedation

Frontiers in Pharmacology

Pharmacology

I-Wen Chen¹  Chien-Cheng Liu²  Shao-Chun Wu³  Cheuk-Kwan Sun⁴  Po-Yu Huang⁵  Jheng-Yan Wu⁶  Ting-Hui Liu⁷  Jen-Yin Chen⁸  Kuo-Chuan Hung⁸ 

[1] Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan;Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan;Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan;Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan;School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan;Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan;Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan;Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan;School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan;Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan;

关键词: ciprofol;    meta-analysis;    sedation;    anesthetic induction;    propofol;   

DOI  :  10.3389/fphar.2023.1225288

 received in 2023-05-19, accepted in 2023-09-15,  发布年份 2023

来源: Frontiers

【 摘 要 】

Background: Ciprofol (HSK3486) is a novel intravenous anesthetic agent that bears structural similarity to propofol and displays favorable pharmacodynamic characteristics such as rapid onset and offset. The meta-analysis aimed at comparing the efficacy and safety of ciprofol versus propofol in clinical practice.Methods: Medline, EMBASE, Google Scholar, Cochrane Library were searched from inception to April 2023. The primary outcome was success rate of sedation/anesthetic induction and differences in sedation/induction time. The secondary outcomes included risks of hemodynamic instability, respiratory complications, and pain on injection, as well as recovery profiles, satisfaction score, and top-up dose requirement.Results: Twelve RCTs (sedation: n = 6, anesthetic induction, n = 6, all conducted in China) involving 1,793 patients (age: 34–58 years) published from 2021 to 2023 were analyzed. Pooled results revealed no differences in success rate [risk ratio (RR) = 1, 95% confidence interval (CI): 0.99 to 1.01, I2 = 0%, 1,106 patients, p = 1] and time required for successful anesthetic induction/sedation [mean difference (MD) = 7.95 s, 95% CI: −1.09 to 16.99, I2 = 97%, 1,594 patients, p = 0.08]. The risks of top-up dose requirement (RR = 0.94, p = 0.48), cardiopulmonary complications [i.e., bradycardia (RR = 0.94, p = 0.67), tachycardia (RR = 0.83, p = 0.68), hypertension (RR = 1.28, p = 0.2), hypoxemia/pulmonary depression (RR = 0.78, p = 0.24)], and postoperative nausea/vomiting (RR = 0.85, p = 0.72), as well as discharge time (MD = 1.39 min, p = 0.14) and satisfaction score (standardized MD = 0.23, p = 0.16) did not differ significantly between the two groups. However, the ciprofol group had lower risks of hypotension (RR = 0.85, p = 0.02) and pain on injection (RR = 0.17, p < 0.00001) than the propofol group. The time to full alertness was statistically shorter in the propofol group (i.e., 0.66 min), but without clinical significance.Conclusion: Our results demonstrated similar efficacy between ciprofol and propofol for sedation and anesthetic induction, while ciprofol was associated with lower risks of hypotension and pain on injection. Future studies are warranted to evaluate the efficacy and safety of ciprofol in pediatric or the elderly populations.Systematic Review Registration: (https://www.crd.york.ac.uk/prospero/), identifier (CRD42023421278).

【 授权许可】

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Copyright © 2023 Hung, Chen, Wu, Huang, Wu, Liu, Liu, Chen and Sun.