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Review
. 2025 Jun 21.
doi: 10.1007/s00540-025-03524-8. Online ahead of print.

Hypnotics as induction agents for general anesthesia in cesarean section patients: updated systematic review and meta-analysis of randomized controlled trials

Sohieb Hedawy  1 , Eman E Labeeb  2 , Shahed Aldalahmeh  3 , Ahmed Elswaf  4 , Ghadeer M AlManaseer  5 , Mohamed Ashraf Shehab  6 , Ahmed Menshawy  7
Affiliations
Review

Hypnotics as induction agents for general anesthesia in cesarean section patients: updated systematic review and meta-analysis of randomized controlled trials

Sohieb Hedawy et al. J Anesth. .

Abstract

Background and purpose: General anesthesia is indicated in emergencies, contraindications, or patient requests. The induction agent to use is an important factor in general anesthesia. We aim to provide an updated systematic review and meta-analysis to compare propofol, ketamine, and thiopental sodium in terms of efficacy and safety profiles in women undergoing cesarean sections under general anesthesia.

Methods: We conducted this systematic review and meta-analysis according to PRISMA guidelines. We searched the following databases (PubMed, Scopus, Cochran Library, and Web of Science) up to 18-8-2024. We used a term for cesarian section, thiopental, ketamine, and propofol.

Results: Thirty-six randomized controlled trials met our criteria and were included in our analysis with a total of 1945 patients. In (Thiopentone vs. Propofol) group, the use of thiopentone was associated with higher umbilical artery PH and longer recovery duration, although the certainty of evidence was low for both outcomes, while in the propofol group, the risk of having neonates with Apgar score less than 7 at one minute was higher, but the certainty of evidence was very low. In (Thiopentone vs. Ketamine) group, patients induced with thiopentone reported accidental awareness during general anesthesia (AAGA) more frequently and their neonates revealed higher umbilical vein PvO2. Also, Apgar score < 7 at 1 and 5 min were less frequent in the thiopentone group. The certainty of evidence for these outcomes was moderate. In (Propofol vs. Ketamine) group, there were no differences among reported outcomes, and the certainty of evidence was low to very low.

Conclusion: Our findings suggest that propofol and thiopentone appear to be clinically comparable. Ketamine was favored over thiopentone for its lower risk of AAGA, while thiopentone was associated with a lower risk of Apgar scores < 7 at 1 and 5 min. Additional well-designed trials are needed to support our conclusions more firmly.

Keywords: And ketamine; Cesarean section; General anesthesia; Propofol; Thiopental.

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Conflict of interest statement

Declarations. Conflict of interest: None of the authors has any conflict of interest to disclose. Ethical Statement: We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this paper is consistent with those guidelines and all authors do give Consent for publication in this journal.

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