Comparative efficacy of ciprofol and propofol in reducing respiratory depression during ERCP anesthesia: a randomized controlled trial

Background Propofol is one of the important drug causes of respiratory depression in endoscopic retrograde cholangiopancreatography (ERCP) anesthesia. This study aims to clarify whether Ciprofol in ERCP anesthesia reduces the respiratory depression rate. Methods In this randomized controlled trial performed at the Surgical Endoscopy Center, the First Hospital of Lanzhou University between Jun 01, 2022 and Feb 20, 2024, patients undergoing ERCP anesthesia were randomly assigned into ciprofol (study group) or propofol (control group). Primary outcomes included respiratory depression rate during anesthesia, and secondary outcomes included body movement and hypoxemia, awakening time, mean arterial pressure and heart rate changes at key points during surgery. Results 20 of the 306 patients had respiratory depression (6.5%). The frequency of respiratory depression was 3.3% in the group C and 9.8% in the group P, with a difference of 6.5% between the two groups (P = 0.035). Ciprofol anesthesia decreased the hyoxemia, injection pain, and circulation and heart rate fluctuations. Multivariable logistic regression analyses showed that Propofol (OR 1.970; 95% CI, 1.121-3.461, P = 0.018), mallampati classification>II (OR 1.594; 95% CI, 1.129-2.249, P = 0.008), and fasting time>10.5 h (OR 3.184; 95% CI, 1.531-6.621, P = 0.002) were independent risk factors for incidence of respiratory depression in ERCP anesthesia. Conclusions For patients undergoing anesthesia for ERCP, Ciprofol, compared to Propofol, has been shown to effectively reduce the incidence of intraoperative respiratory depression, thereby enhancing the safety of the anesthesia process.