- Design
- Single-centre, randomised, assessor-blinded, parallel-group trial
- Population
- 146 adults undergoing laparoscopic cholecystectomy under total intravenous anaesthesia
- Primary outcome
- Cumulative incidence of nausea and vomiting within 24 hours of surgery
- Effect
- 31.5% vs 58.9%; RR 0.53 (95% CI 0.36 to 0.79)
This single-centre trial randomised 146 adults having laparoscopic cholecystectomy to total intravenous anaesthesia with ciprofol or remimazolam. All received dexamethasone and ondansetron prophylaxis and a standard analgesic protocol. Assessors were blinded.
Nausea and vomiting within 24 hours occurred in 23 of 73 (31.5%) on ciprofol and 43 of 73 (58.9%) on remimazolam (RR 0.53, 95% CI 0.36 to 0.79). The result held after adjustment for PONV risk factors (adjusted OR 0.289, 95% CI 0.135 to 0.623). Rescue antiemetic use was also lower. Pain, recovery scores, adverse events and vasopressor use were similar, though the trial was not powered to show equivalence on those.
Both drugs are newer sedative-anaesthetic agents, and whether either is available to you depends on your hospital. This is one small trial, so it is a signal for anaesthesia teams rather than a reason to change the surgeon's plan.
- Remember that PONV is common after laparoscopic cholecystectomy even with two-drug prophylaxis.
- Ask your anaesthetist what agents are used and whether PONV is audited in your unit.
- Continue multimodal antiemetic prophylaxis; this trial did not test dropping it.
- Treat the ciprofol finding as promising, pending multicentre confirmation.
Why it matters
The choice of anaesthetic agent may affect one of the commonest complaints after day-case laparoscopy.
Don't overread it
Single centre and assessor-blinded only; it does not compare against propofol, the usual comparator.
The statistics, in plain English
A relative risk of 0.53 means roughly half the risk of PONV, an absolute difference of about 27 percentage points. A single-centre trial of 146 patients can overstate effects, which is why confirmation is needed.
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