Ciprofol-Esketamine Versus Ciprofol-Remifentanil in Hysteroscopic Endometrial Polypectomy: A Randomized Controlled Trial.

BACKGROUND Although ciprofol is a novel intravenous anesthetic known for its respiratory and hemodynamic stability, its use in hysteroscopic endometrial polypectomy (HEP) has rarely been reported. Therefore, this study investigated the therapeutic potential of a novel combination of ciprofol and esketamine to reduce complications and enhance recovery after HEP. MATERIAL AND METHODS This prospective study enrolled 120 patients with endometrial polyps who underwent HEP. Participants were randomly assigned to receive either ciprofol plus esketamine (group CK, n=60) or ciprofol plus remifentanil (group CR, n=60). Two minutes after an initial bolus of esketamine (0.25 mg/kg) or remifentanil (1 μg/kg), all patients received a standardized ciprofol bolus (0.4 mg/kg). The primary endpoint was transient hypoxemia. Secondary outcomes were hemodynamic parameters, recovery time, ciprofol consumption, adverse events, gynecologist satisfaction, and postoperative Visual Analog Scale (VAS) scores. RESULTS Compared with CR, CK significantly reduced hypoxemia (1.7% vs 35.0%; P<0.001) and hypotension (16.7% vs 33.3%; P=0.035). Post-induction systolic blood pressure was lower in group CR (P=0.047), but other hemodynamic parameters were similar between groups. CK provided superior early analgesia (VAS at 10 min: 2.2±0.7 vs 2.9±0.9; P<0.001). Other outcomes were comparable (P>0.05). CONCLUSIONS The CK combination confers a clinical advantage over the CR combination for HEP. By mitigating the risk of hypoxemia and providing more effective short-term postoperative analgesia, the CK protocol represents a promising and potentially safer sedation regimen.