Propofol Versus Barbiturates as an Inducing Agent in Elective Cesarean Section: Systematic Review and Meta-Analysis

Abstract

Introduction: The choice of the anesthetic agent when it is necessary to provide general anesthesia to the obstetric patient to perform the cesarean section is a controversial issue, especially because the short and long-term effects that it could develop in the newborn are not fully known. Objective: To evaluate the neonatal results of the use of Propofol versus Barbiturates as an inducing agent for anesthesia for elective cesarean section. Methods: A systematic review was carried out with meta-analysis of clinical trials and randomized comparative studies showing neonatal outcomes taking into account the pharmacological comparison according to the neonatal physical state, the adaptive and neurological capacity, the presence of hypoxia and acidosis, as well as the need admission to the intensive care unit. The review was performed in the Cochran library, MEDLINE, EMBASE, Cochran Central Register of Controlled Trial (CENTRAL), PubMed, SCISEARCH, Clinical Trial Registries, EBSCO, LILACS, Sciencedirect, Hinari databases in Spanish and English during the last 35 years, selecting articles from pregnant patients, with single fetuses, without maternal or fetal complications, who are scheduled for elective surgery. Data selection and analysis was carried out by two independent reviewers. Results: 17 studies with 1898 patients were included, 15 compared Propofol vs Thiopental, one study compared Propofol vs Methohexital, one investigation compared Propofol vs Tiamilal. Physical state at one minute of life favored the control group (RR: 1.26; 95% CI: 1.07 and 1.48). There was no relationship between the groups for the rest of the outcomes. Heterogeneity was low in the primary outcome. Conclusions: There was not enough scientific evidence to indicate the superiority of one drug over the other, so both could be good options for elective induction of caesarean section.