背景:丙泊酚广泛用于麻醉,以其有效性而闻名,可能会导致一些患者的心肺问题。环丙泊酚已成为丙泊酚的可能替代品,因为它可以达到与丙泊酚相当的效果,同时在较低剂量下引起的不良事件更少。然而,目前还没有明确的结论。这项荟萃分析旨在评估顺丙泊酚与丙泊酚在全身麻醉下择期手术的成年患者中的有效性和安全性。
方法:我们搜索了PubMed,EMBASE,科克伦图书馆,WebofScience,和中国国家知识基础设施(CNKI),以确定潜在合格的随机对照试验(RCT),比较环丙泊酚和丙泊酚在全身麻醉中的作用,直至2023年9月30日。疗效结果包括诱导成功率,成功诱导开始的时间,睫毛反射消失的时间,和总体估计平均值以双频谱指数(BIS)表示。通过时间到完全警觉性来评估安全性结果,低血压的发生率,心律失常的发生率,和注射部位疼痛的发生率。连续变量表示为平均差(MD),95%置信区间(CI),和二分变量表示为95%CI的风险比(RR)。使用RevMan5.4和STATA14.0进行统计分析。证据的质量是通过建议的分级来评估的,评估,开发和评估(等级)系统。
结果:共分析了来自6个RCTs的712例患者。Meta分析提示顺丙泊酚与丙泊酚的诱导成功率相当,成功诱导开始的时间,睫毛反射消失的时间,时间到完全警觉,和心律失常的发生率,而在BIS的总体估计平均值中,顺丙泊酚优于丙泊酚(MD:-3.79,95%CI:-4.57至-3.01,p<0.001),低血压的发生率(RR:0.63,95%CI:0.42至0.94,p=0.02),和注射部位疼痛的发生率(RR:0.26,95%CI:0.14至0.47,p<0.001)。所有结果都得到了中度到高度证据的支持。
结论:环丙泊酚可能是丙泊酚的一种有希望的替代方案,因为它有助于达到满意的麻醉深度,并减少低血压和注射部位疼痛。然而,我们仍然建议进行更多的大规模研究以验证我们的发现,因为本研究仅积累了有限的数据.
背景:PROSPERO2023CRD42023479767。
BACKGROUND: Propofol is use widely used in anesthesia, known for its effectiveness, may lead to cardiopulmonary issues in some patients. Ciprofol has emerged as a possible alternative to propofol because it can achieve comparable effects to propofol while causing fewer adverse events at lower doses. However, no definitive conclusion has been reached yet. This meta-analysis aimed to evaluate the efficacy and safety of ciprofol versus propofol in adult patients undergoing elective surgeries under general anesthesia.
METHODS: We searched PubMed, EMBASE, the Cochrane library, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) to identify potentially eligible randomized controlled trials (RCT) comparing ciprofol with propofol in general anesthesia until September 30, 2023. The efficacy outcomes encompassed induction success rate, time to onset of successful induction, time to disappearance of eyelash reflex, and overall estimate means in Bispectral Index (BIS). Safety outcomes were assessed through time to full alertness, incidence of hypotension, incidence of arrhythmia, and incidence of injection-site pain. Continuous variables were expressed as mean difference (MD) with 95% confidence interval (CI), and dichotomous variables were expressed as risk ratio (RR) with 95% CI. Statistical analyses were performed using RevMan 5.4 and STATA 14.0. The quality of the evidence was rated through the grading of recommendations, assessment, development and evaluation (GRADE) system.
RESULTS: A total of 712 patients from 6 RCTs were analyzed. Meta-analysis suggested that ciprofol was equivalent to propofol in terms of successful induction rate, time to onset of successful induction, time to disappearance of eyelash reflex, time to full alertness, and incidence of arrhythmia, while ciprofol was better than propofol in overall estimated mean in BIS (MD: -3.79, 95% CI: -4.57 to -3.01, p < 0.001), incidence of hypotension (RR: 0.63, 95% CI: 0.42 to 0.94, p = 0.02), and incidence of injection-site pain (RR: 0.26, 95% CI: 0.14 to 0.47, p < 0.001). All results were supported by moderate to high evidence.
CONCLUSIONS: Ciprofol may be a promising alternative to propofol because it facilitates achieving a satisfactory anesthesia depth and results in fewer hypotension and injection-site pain. However, we still recommend conducting more studies with large-scale studies to validate our findings because only limited data were accumulated in this study.
BACKGROUND: PROSPERO 2023 CRD42023479767.