Effect of Low-Dose Ciprofol on Postoperative Nausea and Vomiting Following Gynecologic Day Surgery: A Randomized Controlled Trial

Xinyuan Shi¹Zongcai Qi²Yaxin Wei¹Hongyi Xiao²Rui Zhang²Guiquan Zhuang²Meixia Zhuang²Aizhen Mou²Fangli Yue²Fanceng Ji^2*Peihe Nie²

• ¹Shandong Second Medical University, Weifang, China
• ²Weifang People's Hospital, Weifang, Shandong Province, China

Purpose: Low-dose propofol has a preventive effect on postoperative nausea and vomiting (PONV). Ciprofol is a new short-acting GABAA receptor agonist developed in China with a similar chemical structure to propofol, but its effect on PONV is unclear.This study examines whether administration of low-dose ciprofol immediately after the start of surgery reduces the incidence of PONV. Patients and methods: In this study, This study enrolled 74 patients undergoing gynecological ambulatory surgery under general anesthesia, and randomly divided the patients into ciprofol group and normal saline control group.In both groups, anaesthesia was induced by remimazolam 0.25 mg/kg, alfentanil 20ug/kg and mivacurium 0.2 mg/kg, followed by remimazolam and alfentanil intravenous infusion for maintenance of anaesthesia.Five minutes after the start of the surgery, the ciprofol group was given 2 ml of ciprofol (5 mg) and the control group was given 2 ml of normal saline.The primary outcome measure was the incidence of PONV in the PACU. Secondary outcomes included the incidence of emetic episodes or nausea in the PACU and within 24 hours, anesthetic time, wake-up time, and administered doses of remimazolam and alfentanil. Safety outcomes encompassed hypotension, hypertension, bradycardia, and tachycardia. Results: The incidence of PONV in the PACU was significantly lower in the ciprofol group compared to the control group (16.2% vs 51.4%; RR=0.32; 95% CI, 0.14–0.70; ARR=0.352; P=0.003). The ciprofol group also exhibited a lower incidence of emetic episodes (defined as retching, vomiting, or both) in the PACU (RR=0.29; 95% CI, 0.10–0.79; ARR=0.27; P=0.013), as well as a lower incidence of nausea (RR=0.32; 95% CI, 0.14–0.70; ARR=0.352; P=0.003). The frequency of emetic episodes or nausea within 24 hours postoperatively was similar between the groups. There were no significant differences between the two groups regarding anesthesia time, wake-up time, remimazolam and alfentanil dosage, or safety indicators (P > 0.05). Conclusion: Low-dose ciprofol can effectively prevent PONV in PACU after gynecological day surgery under general anaesthesia remazolam combined with afentanil, but its effect is limited and cannot reduce the incidence of emetic episodes or nausea within 24 hours after surgery.