Comparative Efficacy and Safety of Ciprofol vs. Propofol for Non-operating Room Sedation and Anesthesia: A Systematic Review and Meta-Analysis

Background: Propofol is a widely used intravenous anesthetic for procedural sedation in non-operating room settings, but its use is often accompanied by adverse events such as injection pain, respiratory depression, and hypotension. Ciprofol, a novel intravenous anesthetic, has gained attention as a potential alternative due to its favorable safety profile and comparable sedative efficacy. This systematic review and meta-analysis aimed to compare the efficacy, safety, and satisfaction outcomes of ciprofol and propofol in adults undergoing non-operating room procedures. Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science to identify randomized controlled trials (RCTs) comparing ciprofol and propofol. Data from eligible studies were extracted and analyzed using RevMan 5.3 and Stata 17. Risk ratio (RR) with 95% confidence interval (CI) were calculated for binary outcomes, and standard mean difference (SMD) with 95% CI were used for continuous outcomes. Heterogeneity was assessed using the I²statistic, with fixed-effects or random-effects models applied as appropriate. Sensitivity and subgroup analyses were performed to explore sources of heterogeneity and ensure robustness. Results: Seven RCTs involving 1,458 participants were included. Ciprofol demonstrated comparable sedation success rates to propofol. Subgroup analyses indicated that combining ciprofol with short-acting opioids significantly improved sedation outcomes (RR 1.07, 95% CI 1.03–1.12; P < 0.01). Ciprofol was associated with significantly lower risks of injection pain (RR 0.13, 95% CI 0.06–0.28; P < 0.01), respiratory depression (RR 0.55, 95% CI 0.33–0.77; P < 0.01), and hypotension (RR 0.81, 95% CI 0.69–0.95; P < 0.01). No significant differences were observed between the two agents in induction time or time to full recovery. Conclusion: Ciprofol is a safe and effective alternative to propofol for non-operating room procedural sedation. Its superior safety profile, particularly in reducing injection pain, respiratory depression, and hypotension, makes it a promising option, especially when combined with short-acting opioids.