Objective: Ciprofol is a novel 2,6-disubstituted
phenol derivative that has improved pharmacokinetic and pharmacodynamic properties compared with
propofol. This study was conducted to compare the efficacy and safety of ciprofol-
remifentanil versus
propofol-
remifentanil for patients undergoing fiberoptic bronchoscopy. Methods: Overall, 92 patients undergoing fiberoptic bronchoscopy were included in this prospective, randomized, double-blind, non-inferiority trial and were equally divided into two groups (n = 46 each).
Fentanyl (50 μg) was given 2 min before the
intravenous infusion of 0.3 mg/kg of ciprofol or 1.2 mg/kg of
propofol over a time period of 30 s. During
anesthesia maintenance, 0.05-0.2 μg/kg/min of
remifentanil combined with one-third to one-fourth of the initial dose of ciprofol or
propofol was repeated at 2-min intervals, as required, to maintain a Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale score <3. The primary outcome was the successful rate of fiberoptic bronchoscopy. Secondary outcomes included demographic characteristics, time metrics, hemodynamics, coughing severity, intubating conditions, lowest oxygen saturation, utilization of study
drug doses, number of remedies (
lidocaine and vasoactive drugs) used, satisfaction scores of both patients and the endoscopist, occurrence of
intraoperative awareness, patients' willing to repeat fiberoptic bronchoscopy, and occurrence and severity of adverse events. Results: The successful completion rate of fiberoptic bronchoscopy was 91.30% (42 of 46; 95% confidence interval [CI]: 82.80%-99.80%) in the ciprofol-
remifentanil group and 89.13% (41 of 46; 95% CI: 79.80%-98.50%) in the
propofol-
remifentanil group. Though the clinically acceptable intubating condition was improved in the ciprofol-
remifentanil group, this difference has no clinical statistical difference (p > 0.05). No significant differences were noted between the two groups with respect to time metrics, consumption of
fentanyl and
remifentanil, or number of remedies (
lidocaine and vasoactive drugs). Patients' willingness to repeat fiberoptic bronchoscopy and the satisfaction of both patients and endoscopist were significantly higher in the ciprofol-
remifentanil than in the
propofol-
remifentanil group (p < 0.05). Compared with patients in the
propofol-
remifentanil group, patients in the ciprofol-
remifentanil group had more stable hemodynamics. The lowest oxygen saturation was significantly higher in the ciprofol-
remifentanil than in the
propofol-
remifentanil group (p < 0.05). The numbers of patients who experienced
pain on injection in the ciprofol-
remifentanil group was significantly lower than the number in the
propofol-
remifentanil group (p < 0.01). Severity of coughing, clinically acceptable severity of coughing, incidence of
intraoperative awareness, and other adverse events were all similar between the two groups (p > 0.05). Only four patients experienced grade 2 adverse events (severe
hypotension in one patient in the ciprofol-
remifentanil group and three patients in the
propofol-
remifentanil group; p > 0.05); they were treated with
noradrenaline. Conclusion: Ciprofol-
remifentanil was non-inferior to
propofol-
remifentanil with regard to successful sedation for flexible bronchoscopy, when used with pre-
intravenous administration of 50 μg of
fentanyl. At the same time, patients' willingness to repeat flexible bronchoscopy and the satisfactions were all significantly improved.