Effects of Ciprofol- versus Remimazolam-Based Total Intravenous Anesthesia on Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract

Background Postoperative nausea and vomiting (PONV) remains common after laparoscopic cholecystectomy. Whether ciprofol-based anesthesia reduces PONV compared with remimazolam-based anesthesia remains unclear. Methods In this single-center, randomized, assessor-blinded, parallel-group trial, adults undergoing laparoscopic cholecystectomy were assigned to receive ciprofol- or remimazolam-based total intravenous anesthesia. All participants received standardized antiemetic prophylaxis with dexamethasone and ondansetron, together with a standardized analgesic protocol. The primary outcome was the cumulative incidence of PONV within 24 h after surgery. Secondary outcomes included nausea, vomiting, rescue antiemetic use, postoperative pain, QoR-15 score, adverse events, and intraoperative hemodynamic variables. Results A total of 146 patients were randomized, with 73 patients in each group. The incidence of PONV within 24 h was lower in the ciprofol group than in the remimazolam group [23/73 (31.5%) vs 43/73 (58.9%); RR 0.53, 95% CI 0.36–0.79; P = 0.001]. This association remained significant after adjustment for clinically relevant PONV risk factors(adjusted OR 0.289, 95% CI 0.135–0.623; P = 0.002). Ciprofol was also associated with lower incidences of nausea, vomiting, and rescue antiemetic use. Postoperative pain, QoR-15 score, overall adverse events, and vasopressor use were similar between groups. Conclusion Under a standardized prophylactic antiemetic protocol, ciprofol-based total intravenous anesthesia was associated with a lower 24-h incidence of PONV than remimazolam-based anesthesia in adults undergoing laparoscopic cholecystectomy. No statistically significant between-group differences were observed in postoperative recovery measures, adverse events, or vasopressor use; however, the trial was not powered to establish equivalence for these secondary or safety outcomes. Further multicenter studies are needed to confirm the robustness and generalizability of this finding across different multimodal antiemetic strategies.