Efficacy and safety of ciprofol versus propofol in hysteroscopy: a systematic review and meta-analysis

Hysteroscopy is a minimally invasive procedure for diagnosing and treating intrauterine conditions. Adverse effects such as injection pain and hypotension are common with propofol, the standard anesthetic agent. Emerging evidence suggests ciprofol may be a safer alternative, but its role in hysteroscopy remains unclear. A systematic search of MEDLINE, Embase, Cochrane, and Web of Science was conducted, following the recommendations of the Cochrane Handbook and the PRISMA statement. The measure of association used was risk ratio (RR) or Standardized Mean Difference (SMD), with 95% Confidence Intervals (CIs), identifying randomized controlled trials (RCTs) comparing intravenous ciprofol and propofol in hysteroscopy patients aged ≥18 years. Risk Ratio (RR) and mean difference (MD) with 95% CIs were calculated using a random-effects model. Statistical analyses were performed using R software (version 4.2.2). Trial Sequential Analysis (TSA) was used to evaluate the robustness of the findings. Four RCTs with 1512 patients (49.8% ciprofol group) showed that ciprofol was associated with a significant reduction in injection pain (RR=0.18; 95% CI: 0.06-0.51) and hypotension (RR=0.57; 95% CI: 0.49-0.67). TSA and sensitivity analyses confirmed these findings, demonstrating sufficient statistical power. Ciprofol was also associated with a reduction in hypoxemia (RR=0.54; 95% CI: 0.39-0.75) and body movement (RR=0.55; 95% CI: 0.40-0.76), with no significant differences in bradycardia, induction, or recovery time. This meta-analysis with TSA supports ciprofol as a safer, effective alternative to propofol for hysteroscopy, reducing key adverse effects.