Ciprofol eases emergence agitation after laparoscopic surgery better than propofol

Patients undergoing laparoscopic surgery who received the novel anesthetic ciprofol instead of propofol woke up more calmly, with markedly less restlessness on emergence, according to a randomized controlled trial published in BMC Anesthesiology. The study also found that recovery times and depth-of-anesthesia measures were similar between the two drugs, suggesting that ciprofol’s advantage lies specifically in the quality of awakening rather than in how quickly patients recover.

Ciprofol, also known by its development code HSK3486, is a gamma-aminobutyric acid type A receptor agonist that provides anesthetic efficacy comparable to propofol, the long-standing standard agent for induction and maintenance of general anesthesia.

The study was a prospective, single-center, randomized, parallel controlled trial registered with the Chinese Clinical Trial Registry (ChiCTR2400085402). Researchers enrolled patients scheduled for elective laparoscopic surgery under general anesthesia and randomly assigned them in a 1:1 ratio to receive either ciprofol or propofol for both anesthesia induction and maintenance. The primary endpoint was the restlessness score after awakening, a direct measure of emergence agitation.

Between August 9, 2024, and September 29, 2025, 94 patients were randomly assigned, with 47 receiving ciprofol and 47 receiving propofol. Patients in the ciprofol group had a significantly lower mean restlessness score after awakening, 0.17 versus 0.48, a difference that was statistically significant. A substantially higher proportion of patients in the ciprofol group achieved a restlessness score of zero after awakening, 83.0 percent compared with 58.7 percent in the propofol group.

Recovery quality measured with the quality of recovery-15 questionnaire on the first day after surgery also favored ciprofol. The mean total score was 125.38 in the ciprofol group versus 120.60 in the propofol group, a mean difference of 4.780 with a 95 percent confidence interval of 0.298 to 9.277. While the confidence interval sits close to the boundary of no difference, the reported difference was statistically significant, indicating a modest but measurable benefit in self-reported recovery one day after surgery.

Not all measures differed between the groups. Bispectral index values, which monitor anesthetic depth, and vital signs were generally comparable at different time points. Times from discontinuation of the anesthetic agents to leaving the operating room were nearly identical, 15.55 minutes for ciprofol versus 15.20 minutes for propofol. Times to extubation, 14.19 versus 12.53 minutes, and to recovery of spontaneous breathing, 5.98 versus 5.50 minutes, were also comparable, with no statistically significant differences reported for any of these endpoints.

Safety findings added another dimension to the comparison. No patients in either group experienced intraoperative awareness, an important safety outcome. Ciprofol produced significantly lower rates of injection-site pain, affecting 2.13 percent of patients compared with 23.40 percent of those receiving propofol.

Postoperative nausea and vomiting occurred in both groups, at 12.77 percent in the ciprofol group and 21.28 percent in the propofol group. The reported figures suggest a numerical trend favoring ciprofol, but the abstract does not report a statistical comparison for this outcome, so no firm conclusion about a difference in nausea and vomiting can be drawn from the available data.

The authors concluded that, compared with propofol, ciprofol was associated with reduced emergence agitation and injection-site pain in patients undergoing laparoscopic surgery under general anesthesia. As a single-center study with 94 patients and a parallel controlled design, the findings will need confirmation in larger and more diverse populations before they can guide routine anesthetic practice, but they add to the evidence base for this novel GABAA receptor agonist as a candidate alternative to propofol.

Subject of Research: Comparison of ciprofol and propofol for postoperative recovery quality after laparoscopic surgery under general anesthesia

Article Title: Effect of ciprofol versus propofol on postoperative recovery quality after laparoscopic surgery under general anesthesia: a prospective, randomized, parallel controlled study

Article References: Song, J., Guan, S., Ding, W., Du, Y., Zhao, W., Guo, C., He, L., Feng, Y., & An, H. (2026). Effect of ciprofol versus propofol on postoperative recovery quality after laparoscopic surgery under general anesthesia: a prospective, randomized, parallel controlled study. BMC Anesthesiology. https://doi.org/10.1186/s12871-026-04374-x

Image Credits: AI Generated

DOI: 10.1186/s12871-026-04374-x

Keywords: ciprofol, propofol, laparoscopic surgery, general anesthesia, emergence agitation, restlessness score, QoR-15, injection-site pain, randomized controlled trial, anesthesia recovery, BMC Anesthesiology, HSK3486