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Meta-Analysis
. 2025 Dec;39(6):948-975.
doi: 10.1007/s00540-025-03524-8. Epub 2025 Jun 21.

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
Meta-Analysis

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. 2025 Dec.

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.

Figures

Fig. 1
Fig. 1
The PRISMA flow diagram of studies screening and selection
Fig. 2
Fig. 2
A Risk of Bias analysis of the included studies in our systematic review and meta-analysis.” + ” indicates low risk;”-” indicates high risk and”!” indicates some concerns
Fig. 3
Fig. 3
Forest plot of mean difference in pH in UA, thiopentone vs. Propofol
Fig. 4
Fig. 4
Comparison of the number of newborns with Apgar score < 7 at 1 min after delivery, thiopentone vs. propofol
Fig. 5
Fig. 5
Comparison of the number of newborns with Apgar score < 7 at 5 min after delivery, thiopentone vs. propofol
Fig. 6
Fig. 6
Forest plot of mean difference in Recovery duration, thiopentone vs. propofol
Fig. 7
Fig. 7
Forest plot of mean difference in PO2 in UV, thiopentone vs. ketamine
Fig. 8
Fig. 8
Comparison of number of infants having Apgar score < 7 at 1 min after delivery, Thiopentone vs. Ketamine
Fig. 9
Fig. 9
Comparison of number of infants having Apgar score < 7 at 5 min after delivery, Thiopentone vs. Ketamine
Fig. 10
Fig. 10
Comparison of number of patients suffered from AAGA, Thiopentone vs. Ketamine
See this image and copyright information in PMC

References

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