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. 2025 May 8;25(1):230.
doi: 10.1186/s12871-025-03108-9.

The safety and efficacy of remimazolam, ciprofol, and propofol anesthesia in endoscopy: a systematic review and network meta-analysis

Siqi Zhou #  1 , Shangchen Yu #  1 , Yuan Bi  1 , Zhang Tian  1 , Ruochen Pan  1 , Tianqing Yan  1 , Jianbo Deng  1 , Aijun Xu  2
Affiliations

The safety and efficacy of remimazolam, ciprofol, and propofol anesthesia in endoscopy: a systematic review and network meta-analysis

Siqi Zhou et al. BMC Anesthesiol. .

Abstract

Background: While propofol remains widely used for endoscopic sedation, its cardiovascular depression and injection pain limitations have prompted exploration of novel agents (remimazolam, ciprofol). This study aimed to compare their safety and efficacy profiles systematically.

Methods: We conducted a network meta-analysis to evaluate remimazolam, ciprofol, and propofol for gastrointestinal endoscopy. Bayesian random-effects models were used to estimate relative risks (RR) and mean differences (MD) with 95% credible intervals(CrI).

Results: Forty-two randomized controlled trials (N = 10,540 patients) were included. Remimazolam demonstrated superior cardiovascular safety (RR = 0.44, 95%CrI 0.35-0.54 vs propofol) and lowest respiratory depression risk (RR = 0.36, 0.28-0.46). Propofol showed faster recovery (MD -14.22 min, -2.35 to -30.83 vs remimazolam). Both remimazolam (RR = 0.045) and ciprofol (RR = 0.054) significantly reduced injection pain versus propofol.

Conclusion: Remimazolam should be prioritized for high-risk patients (cardiovascular/respiratory comorbidities) despite slightly longer recovery times. Propofol remains suitable for low-risk procedures requiring rapid turnover, while ciprofol offers balanced efficacy for endoscopy.

Trial registration: The study was registered with the UK National Institute for Health Research's PROSPERO platform (CRD42024569405; https://www.crd.york.ac.uk/prospero/ ).

Keywords: Anesthesia; Ciprofol; Endoscopy; Propofol; Remimazolam; Sedation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was registered with the UK National Institute for Health Research's PROSPERO platform (CRD42024569405; https://www.crd.york.ac.uk/prospero/ ). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study Flow Chart
Fig. 2
Fig. 2
Risk of Bias Summary Chart
Fig. 3
Fig. 3
A Forest Plot of Respiratory Adverse Events. B Forest Plot of Cardiac Adverse Events
Fig. 4
Fig. 4
A Cumulative Probability Distribution Diagram of Respiratory Adverse Events. B Cumulative Probability Distribution Diagram of Cardiac Adverse Events
Fig. 5
Fig. 5
Network map for Cardiac adverse events for x-node analysis. The size of the node corresponds to the number of patients randomised to that intervention. The thickness of the line and the associated numbers correspond to the number of studies comparing the two linked interventions
See this image and copyright information in PMC

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