Ciprofol–lidocaine combination for sedation in gastrointestinal endoscopy: a systematic review and meta-analysis protocol

Ciprofol is a recently introduced intravenous hypnotic agent with sedative efficacy comparable to that of propofol while conferring superior haemodynamic stability and a lower incidence of adverse events. Intravenous lidocaine, widely employed as an adjuvant to propofol-based sedation, has been shown to reduce hypnotic requirements and may facilitate recovery. Nevertheless, no systematic synthesis has yet appraised the combined use of these two agents in the context of gastrointestinal endoscopy. The present protocol delineates the methodology for a systematic review and meta-analysis designed to determine whether the addition of intravenous lidocaine as an adjuvant to ciprofol-based sedation confers improvements in procedural efficacy and safety relative to ciprofol alone. The review will adhere to PRISMA guidelines and has been prospectively registered with PROSPERO (CRD420251166027). Inclusion will be restricted to randomised controlled trials comparing the ciprofol–lidocaine combination with ciprofol alone in adult patients undergoing gastrointestinal endoscopy. The primary outcome will be the total cumulative ciprofol dose administered during the endoscopic procedure, expressed in mg.patient⁻¹, from the induction of sedation through to procedural completion. Data will be synthesised using fixed or random effects models as dictated by the degree of heterogeneity, with risk of bias appraised using the RoB 2.0 tool and certainty of evidence graded according to the GRADE framework. This review will be the first comprehensive synthesis of the evidence pertaining to the efficacy and safety of intravenous lidocaine as an adjunct to ciprofol-based sedation, thereby informing future multimodal sedation strategies and clinical practice.