Drugs Aging. 2026 Jul 1. doi: 10.1007/s40266-026-01306-9. Online ahead of print.
ABSTRACT
BACKGROUND AND OBJECTIVE: Propofol is widely used in clinical anesthesia, but its cardiorespiratory depressive effects may limit its safety in older patients. With the growing number of older adults requiring anesthesia, ciprofol has attracted interest because of its higher potency and relatively mild hemodynamic impact. This meta-analysis evaluated the efficacy and safety of ciprofol compared with propofol in older patients undergoing general anesthesia or painless endoscopy.
METHODS: We conducted a comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science up to 7 November, 2025, to identify eligible studies. All statistical analyses were performed using RevMan 5.4 and R version 4.5.1.
RESULTS: A total of 12 randomized controlled trials involving 2027 older participants were included. For safety outcomes, ciprofol significantly reduced the incidence of hypotension (risk ratio = 0.76, 95% confidence interval 0.68-0.84; p < 0.00001) and injection pain (risk ratio = 0.16, 95% confidence interval 0.09-0.26; p < 0.00001) compared with propofol. No significant differences were observed between the two agents in the incidence of bradycardia, hypoxemia, and postoperative nausea and vomiting. Regarding efficacy outcomes, ciprofol was associated with a longer time to loss of consciousness compared with propofol (mean difference = 4.67 seconds, 95% confidence interval 0.65-8.70; p = 0.02), while no significant differences were observed in anesthesia success rate, procedure completion rate, and awakening time.
CONCLUSIONS: Based on the currently available evidence from randomized trials conducted in China, ciprofol showed comparable efficacy to propofol and was associated with lower incidences of hypotension and injection pain in older patients. These findings may still be informative for anesthetic management in broader settings, although further validation is needed.
CLINICAL TRIAL REGISTRATION: PROSPERO registration number: CRD420251179366.
PMID:42387086 | DOI:10.1007/s40266-026-01306-9
