Navigating Endoscopic Sedation: Study Compares Safety Profiles of Propofol, Remimazolam, and Ciprofol

As endoscopic procedures become increasingly common, the choice of sedative agent used during these delicate procedures is of paramount importance. While propofol remains a widely utilized option, its limitations related to cardiovascular depression and injection pain have prompted the exploration of novel sedatives like remimazolam and ciprofol. A recent systematic review and network meta-analysis set out to provide a comprehensive comparison of these three anesthetic agents in the context of endoscopic sedation. The study examined a range of primary and secondary outcomes, including respiratory adverse events, cardiac adverse events, induction time, sedation recovery time, injection pain, gastrointestinal adverse events, and patient satisfaction. The findings paint a nuanced picture of the strengths and weaknesses of each medication. Respiratory Safety: Remimazolam and Ciprofol Shine One of the key findings was the significantly lower risk of respiratory adverse events with remimazolam and ciprofol compared to propofol. The analysis showed that the risk ratios for respiratory adverse events were 0.36 for remimazolam and 0.48 for ciprofol, relative to propofol. This suggests that remimazolam and ciprofol may be safer options for patients with compromised respiratory function, such as those with COPD or sleep apnea. Cardiovascular Considerations: Remimazolam Emerges as the Frontrunner The study also evaluated the impact of these sedatives on the cardiovascular system. Remimazolam demonstrated a 56% reduction in the risk of adverse cardiac events, such as hypotension and bradycardia, compared to propofol. Ciprofol also fared better than propofol in this regard, with a 24% lower risk of cardiac complications. These findings suggest that remimazolam may be the preferred choice for patients with pre-existing cardiovascular conditions. Injection Pain and Patient Satisfaction: Remimazolam and Ciprofol Shine One of the notable advantages of remimazolam and ciprofol was their ability to significantly reduce the incidence of injection pain compared to propofol. Both agents demonstrated an over 90% reduction in the risk of injection pain, which can greatly enhance the patient experience during the induction of anesthesia. Additionally, patient satisfaction scores tended to be higher with remimazolam and ciprofol, although the differences did not reach statistical significance. Navigating the Tradeoffs: Tailoring Sedation to Patient Needs The study highlights the importance of considering individual patient characteristics and procedural requirements when selecting the optimal sedative agent. For patients with respiratory or cardiovascular comorbidities, remimazolam emerges as the safer choice, while ciprofol may be preferred for gastrointestinal endoscopic procedures due to its favorable gastrointestinal tolerance profile. In settings where rapid turnover is crucial, propofol's shorter induction and recovery times may be advantageous, but the trade-off is the higher risk of adverse effects. In conclusion, this comprehensive analysis provides valuable insights for clinicians navigating the complex landscape of endoscopic sedation. By understanding the unique strengths and limitations of propofol, remimazolam, and ciprofol, healthcare providers can make informed decisions that prioritize patient safety and optimize the procedural experience. As the field of endoscopic sedation continues to evolve, further research exploring combination strategies and long-term cognitive impacts will be crucial to refine these evidence-based guidelines.

Key Points

Here are the 6 key points from the research paper:

1. Remimazolam had the lowest risk of respiratory adverse events compared to propofol (RR = 0.36) and ciprofol (RR = 0.48).

2. Remimazolam had the lowest risk of cardiovascular adverse events compared to propofol (RR = 0.44) and ciprofol (RR = 0.76).

3. Remimazolam and ciprofol had significantly lower incidence of injection pain compared to propofol.

4. Ciprofol had the lowest incidence of gastrointestinal adverse events, followed by remimazolam and propofol.

5. Remimazolam had the highest probability of ranking first in terms of patient satisfaction, exceeding both ciprofol and propofol. 6. Propofol had the shortest induction and awakening times, but was associated with higher rates of cardiovascular/respiratory events and injection pain.

Reference –

Siqi Zhou et al. (2025). The Safety And Efficacy Of Remimazolam, Ciprofol, And Propofol Anesthesia In Endoscopy: A Systematic Review And Network Meta-Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03108-9.