Ciprofol versus propofol and the risk of hemodynamic adverse events: a meta-analysis with trial sequential analysis of randomized controlled trials.

INTRODUCTION

Intraoperative hypotension increases postoperative risks. Ciprofol, a novel anesthetic, has an onset and recovery profile comparable to propofol, but its potential superiority in mitigating intraoperative hypotension is unclear. This meta-analysis compares the incidence of intraoperative hypotension between ciprofol and propofol.

METHODS

A comprehensive search of PubMed, Embase, and the Cochrane Library was performed up to December 10, 2025, to identify randomized controlled trials comparing ciprofol and propofol. Data were analyzed using RevMan and Stata. Subgroup analyses were conducted according to age, anesthetic dose, and type of procedure. Trial sequential analysis (TSA) was used to assess the robustness and sufficiency of the evidence.

RESULTS

This meta-analysis of 34 trials (5,162 patients) found that ciprofol was associated with a significantly lower risk of intraoperative hypotension compared to propofol (RR = 0.65, 95% CI 0.57-0.73). This benefit was consistent across various subgroups, including different age groups, dose ranges, and procedure types. Ciprofol also demonstrated lower incidences of respiratory depression (RR = 0.44), injection pain (RR = 0.19), and hypoxemia (RR = 0.62), but was associated with a very small, likely clinically insignificant increase in awakening time;however, these findings are based on secondary outcomes and should be interpreted as exploratory. Trial sequential analysis confirmed sufficient sample size for the intraoperative hypotension and injection pain outcomes. The certainty of the evidence, assessed using the GRADE approach, was rated as low to moderate.

CONCLUSIONS

Ciprofol was associated with a reduced incidence of intraoperative hypotension compared with propofol, with comparable anesthetic efficacy. Nevertheless, due to heterogeneity and overall low-to-moderate certainty of evidence, these findings should be interpreted with caution. Further large-scale, well-designed randomized controlled trials are warranted to validate these results and delineate the clinical benefits of ciprofol.