Optimal dosing of ciprofol for gastrointestinal endoscopy: a systematic review and network meta-analysis

The use of ciprofol for endoscopic sedation is relatively recent; however, no definitive conclusions have been drawn regarding its optimal dose. This study evaluated the optimal ciprofol dose for sedated endoscopy using a network meta-analysis.

PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP Chinese scientific and technological journal full-text database, and SinoMed were searched from inception to July 2025. The review incorporated all available comparative trials assessing ciprofol versus propofol for endoscopic sedation. The primary outcome was the incidence of injection pain and adverse cardiopulmonary reactions.

A total of 52 randomized controlled trials (RCTs) involving 7283 patients were included. Ciprofol demonstrated a significantly lower incidence of injection pain, respiratory depression, bradycardia, and hypotension compared to propofol. Compared with propofol 2 mg/kg, ciprofol 0.4 mg/kg were associated with a significantly lower incidence of injection pain (RR[95%CrI] = 0.13[0.08, 0.21], high confidence), respiratory depression (RR[95%CrI] = 0.36[0.26, 0.48], high confidence), and hypotension (RR[95%CrI] = 0.62[0.44, 0.84], moderate confidence).

A dose of 0.4 mg/kg of ciprofol may represent the optimal dose for endoscopic sedation, as it can reduce the incidence of injection pain, respiratory depression, and hypotension. However, most included studies focus on Chinese populations, which limits the global applicability of the findings. Future RCTs conducted in more countries are warranted.