Ciprofol-based anaesthesia halved postoperative nausea versus remimazolam

Design

Single-centre, assessor-blinded randomised controlled trial

Population

146 adults undergoing laparoscopic cholecystectomy on standardised antiemetics

Primary outcome

Cumulative PONV within 24 hours

Effect

31.5% vs 58.9% (relative risk 0.53, 95% CI 0.36-0.79, P=0.001)

Postoperative nausea and vomiting is common after laparoscopic cholecystectomy even with antiemetic prophylaxis, and the choice of intravenous anaesthetic may matter. This randomised trial compared ciprofol-based with remimazolam-based total intravenous anaesthesia, all patients receiving dexamethasone and ondansetron.

Among 146 adults, PONV within 24 hours was markedly lower with ciprofol: 31.5% versus 58.9% (relative risk 0.53, 95% CI 0.36 to 0.79, P=0.001), and the difference held after adjustment for PONV risk factors (adjusted odds ratio 0.29). Nausea, vomiting and rescue antiemetic use were all lower with ciprofol, while pain, recovery quality, adverse events and vasopressor use were similar.

For practice, in a nausea-prone patient having laparoscopic surgery, ciprofol-based anaesthesia is worth preferring over remimazolam where it is available, on top of standard antiemetics. The main caveats are access and evidence breadth: ciprofol is not yet widely available outside some markets, and this is a single-centre result needing confirmation.

• Randomised trial of 146 laparoscopic cholecystectomy patients on standard dexamethasone and ondansetron.
• 24-hour PONV was 31.5% with ciprofol versus 58.9% with remimazolam (relative risk 0.53, P=0.001).
• The benefit persisted after adjustment for PONV risk factors (adjusted odds ratio 0.29).
• Nausea, vomiting and rescue antiemetic use were all lower with ciprofol; recovery and adverse events were similar.
• Prefer ciprofol over remimazolam in nausea-prone laparoscopic patients where it is available.

Why it matters

It shows the anaesthetic agent itself, not just antiemetics, can substantially change PONV, which is a frequent and distressing complication.

Don't overread it

This single-centre trial establishes a PONV benefit, not overall superiority; ciprofol availability remains limited outside some markets and safety equivalence was not formally tested.

The statistics, in plain English

A relative risk of 0.53 means about half the PONV rate, and the confidence interval (0.36 to 0.79) stays well below 1.0, so the effect is unlikely to be chance; it is, however, a single-centre trial not powered to confirm safety equivalence.

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