|
Author and year |
Desing |
Intervention (total participants) |
Measurement of variables |
Outcomes |
Results |
|
Abboud, 1995 |
Clinical trial |
Experimental group (Propofol): 37 patients Control group (Tiamilal): 37 patients |
Physical state 1 and 5 minutes (Apgar scale) acid base state adaptive and neurological capacity 2 hours and 24 hours (Neurological and Adaptive capacity score NACS) |
Apgar <7 Alterations in the acid-base state NACS <35 |
Neonatal status (Apgar scale), acid-base status, and adaptive and neurological capacity were good in both research groups. |
|
Capogna, 1991 |
Randomized double-blind clinical trial |
Experimental group (Propofol): 28 patients Control group (Thiopental): 28 patients |
Physical state 1 and 5 minutes (Apgar scale) acid base state adaptive and neurological capacity at 15 minutes, 2 hours, 24 hours (Neurological and Adaptive capacity score NACS) |
Apgar <7 Alterations in the acid-base state NACS <35 |
Neonates in the Propofol group obtained a low Apgar score at one minute of life, but there were no differences between the groups at five minutes of life. |
|
Celleno, 1989 |
Randomized comparative clinical study |
Experimental group (Propofol): 20 patients Control group (Thiopental): 20 patients |
Physical state 1 and 5 minutes (Apgar scale) adaptive and neurological capacity at 24 hours (Neurological and Adaptive capacity score NACS) |
Apgar <7 ENNS <35 |
Infants in the Propofol group were lowest at 1 and 5 minutes, with 25% muscle hypotonia at 5 minutes. Hypotonia was not found with the early neuroadaptation |
|
Celleno, 1993 |
Randomized comparative clinical study |
Experimental group (Propofol): 30 patients Control group (Thiopental): 30 patients |
Physical state 1 and 5 minutes (Apgar scale) adaptive and neurological capacity at 15 minutes, 2 hours, 24 hours (Neurological and Adaptive capacity score NACS) |
Apgar < 7 NACS< 35 |
The Apgar score was lower in the Propofol group than in the Thiopental group. There was no difference between the groups and the acid base state. |
|
Dailland, 1989 |
Randomized comparative clinical study |
Phase I group: propofol for bolus induction iv. Phase II group: propofol for induction and maintenance. |
Physical state 1 and 5 minutes (Apgar scale) acid base state adaptive and neurological capacity 2 hours and 24 hours (Neurological and Adaptive capacity score NACS) adaptive and neurological capacity at 15 minutes, 2 hours, 24 hours (Neurological and Adaptive capacity score NACS) |
Apgar <7 Alterations in the acid-base state NACS <35 |
Minimal deleterious effects on the health of newborns were observed in the Propofol group |
|
Gin, 1993 |
Randomized comparative clinical study |
Experimental group (Propofol): 30 patients Control group (Thiopental): 32 patients |
Physical state 1 and 5 minutes (Apgar scale) acid base state adaptive and neurological capacity at 15 minutes, 2 hours, 24 hours (Neurological and Adaptive capacity score NACS) Admission to Neonatal Intensive Unit Care |
Apgar <7 Alterations in the acid-base state NACS <35 Need for income |
Neonatal Apgar scale, neuroadaptation scale, umbilical cord catecholamines, blood gases, oxygen content were similar in both groups |
|
Gregory, 1990 |
Randomized comparative clinical study |
Experimental group (Propofol): 10 patients Control group (Thiopental): 10 patients |
Physical state 1 and 5 minutes (Apgar scale) adaptive and neurological capacity at 15 minutes, 2 hours, 24 hours (Neurological and Adaptive capacity score NACS) |
Apgar <7 NACS <35 Alterations in the acid-base state |
The Apgar scale and blood gas analysis were similar in both groups |
|
Mamidi, 2011 |
Randomized double-blind controlled clinical trial |
Experimental group (Propofol): 115 patients Control group (Thiopental): 115 patients |
Physical state 1 and 5 minutes (Apgar scale) |
Apgar < 7 |
The Apgar scale at 1 and 5 minutes of life were higher in the Propofol group than in the Thiopental group |
|
Miranda, 1992 |
Randomized comparative clinical study |
Experimental group (Propofol): 30 patients Control group (methohexytone): 30 patients |
Physical state 1 and 5 minutes (Apgar scale) |
Apgar < 7 |
There were no differences between the groups in the Apgar score and blood gas analysis. |
|
Montandrau, 2019 |
Randomized comparative clinical study |
Experimental group (Propofol): 189 patients Control group (Thiopental): 178 patients |
Physical state 1 and 5 minutes (Apgar scale) acid base state Neonatal intensive care admission |
Apgar <7 Alterations in the acid-base state NACS <35 Need for income |
The use of Propofol was a risk to obtain low Apgar at one minute of life. Blood gas analysis and admission to therapy were similar in both groups |
|
Moore, 1989 |
Randomized clinical trial |
Experimental group (Propofol): 21 patients Control group (Thiopentone): 21 patients |
Physical state 1 and 5 minutes (Apgar scale) acid base state Neonatal intensive care admission |
Apgar <7 Alterations in the acid-base state NACS <35 Necesidad de ingreso |
Fetal evaluation was slightly better in the Thiopental group than in the Propofol group. |
|
Sahraei, 2014 |
Double-blind randomized controlled clinical trial |
Experimental group (Propofol): 54 patients Control group (Thiopental): 54 patients |
Physical state 1 and 5 minutes (Apgar scale) |
Apgar < 7 |
There were no statistically significant differences in neonatal vitality between the groups. |
|
Tolyat, 2016 |
Double-blind controlled clinical trial |
Experimental group (Propofol): 28 patients. Control group (Thiopental): 28 patients. Experimental group (Propofol + Thiopental): 28 patients. |
physical state 1 and 5 minutes (Apgar scale) |
Apgar < 7 |
There were differences between the groups and Propofol is proposed as the most appropriate agent for anesthetic induction. |
|
Tumukunde, 2015 |
Randomized controlled clinical trial |
Experimental group (Propofol): 75 patients Control group (Thiopental): 75 patients |
Physical state 1 and 5 minutes (Apgar scale) Neonatal intensive care admission |
Apgar <7 Need for income |
There were no differences between the two study groups. |
|
Valtonen, 1989 |
open clinical trial |
Experimental group (Propofol): 16 patients Control group (Thiopentone): 16 patients |
Physical state 1 and 5 minutes (Apgar scale) acid base state |
Apgar <7 Alterations in the acid-base state |
There were no differences between the two study groups in terms of the Apgar scale and blood gas analysis. |
|
Yau, 1991 |
Randomized comparative clinical study |
Experimental group (Propofol): 20 patients Control group (Thiopentone): 20 patients |
Physical state 1 and 5 minutes (Apgar scale) acid base state adaptive and neurological capacity at 15 minutes, 2 hours, 24 hours (Neurological and Adaptive capacity score NACS) |
Apgar <7 Alterations in the acid-base state NACS <35 |
The Apgar scale and the neurological adaptation scale were similar in the two groups |
|
Çakirtekin, 2015 |
Randomized comparative clinical study |
Experimental group (Propofol): 35 patients Control group (Thiopentone): 35 patients |
Physical state 1 and 5 minutes (Apgar scale) acid base state |
Apgar <7 Alterations in the acid-base state |
The Apgar score at 1 and 5 minutes of life, blood gas analysis was similar in both groups |
Seventeen studies report the physical state of the newborn in the first minute (Abboud et al., 1995; Capogna et al., 1991; Celleno et al., 1989; Celleno et al., 1993; Dailland et al., 1989; Gin et al., 1993; Gregory et al., 1990; Mamidi et al., 2011; Miranda et al., 1992; Montandrau et al., 2019; Moore et al., 1989; Saharei et al., 2014; Tolyat et al., 2016; Tumukunde et al., 2015; Valtonen et al., 1989, Yau et al., 1991; Cakrtekin et al., 2015); seventeen investigations report data on the physical state of the newborn at five minutes (Abboud et al., 1995; Capogna et al., 1991; Celleno et al., 1989; Celleno et al., 1993; Dailland et al., 1989; Gin et al., 1993; Gregory et al., 1990; Mamidi et al., 2011; Miranda et al., 1992; Montandrau et al., 2019; Moore et al., 1989; Saharei et al., 2014; Tolyat et al., 2016; Tumukunde et al., 2015; Valtonen et al., 1989, Yau et al., 1991; Cakrtekin et al., 2015); six studies evaluate adaptive and neurological capacity between 15 and 30 minutes of life (Capogna et al., 1991; Celleno et al., 1993; Dailland et al., 1989; Gin et al., 1993; Gregory et al., 1990; Yau et al., 1991); seven studies acquire data on adaptive and neurological capacity at two hours (Abboud et al., 1995; Capogna et al., 1991; Celleno et al., 1993; Dailland et al., 1989; Gin et al., 1993; Gregory et al., 1990; Yau et al., 1991); seven studies confirmed adaptive and neurological capacity at 24 hours of life (Abboud et al., 1995; Capogna et al., 1991; Celleno et al., 1993; Dailland et al., 1989; Gin et al., 1993; Gregory et al., 1990; Yau et al., 1991); nine investigations report the newborn's pH values (Abboud et al., 1995; Capogna et al., 1991; Dailland et al., 1989; Gin et al., 1993; Montandrau et al., 2019; Moore et al., 1989; Valtonen et al., 1989; Yau et al., 1991; Cakrtekin et al., 2015); seven studies show the BE values of the newborn (Abboud et al., 1995; Capogna et al., 1991; Dailland et al., 1989; Gin et al., 1993; Valtonen et al., 1989; Yau et al., 1991; Cakrtekin et al., 2015); Nine studies report newborn pCO2 values (Abboud et al., 1995; Capogna et al., 1991; Dailland et al., 1989; Gin et al., 1993; Montandrau et al., 2019; Moore et al., 1989; Valtonen et al., 1989; Yau et al., 1991; Cakrtekin et al., 2015); nine studies show the pO2 values of the newborn (Abboud et al., 1995; Capogna et al., 1991; Dailland et al., 1989; Gin et al., 1993; Montandrau et al., 2019; Moore et al., 1989; Valtonen et al., 1989; Yau et al., 1991; Cakrtekin et al., 2015); four investigations on HCO3 values (Capogna et al., 1991; Gin et al., 1993; Valtonen et al., 1989; Cakrtekin et al., 2015); and four studies stated the need for intensive care (Gin et al., 1993; Montandrau et al., 2019; Moore et al., 1989; Tumukunde et al., 2015) as key outcomes.
Intervention and Comparison
Propofol vs Tiamilal
One study compared Propofol and Thiamilal as inducing anesthetic agents in caesarean section (Abboud et al., 1989).
Propofol vs Methohexitone
One work carried out the comparison between Propofol and Methohexitone as inducing anesthetic agents in caesarean section (Miranda et al., 1992).
Propofol vs Thiopental / Thiopentone
Fifteen investigations developed the comparison of Propofol versus Thiopental as anesthetic inducing agents in cesarean section (Capogna et al., 1991; Celleno et al., 1989; Celleno et al., 1993; Dailland et al., 1989; Gin et al., 1993; Gregory et al., 1990; Mamidi et al., 2011; Montandrau et al., 2019; Moore et al., 1989; Saharei et al., 2014; Tolyat et al., 2016; Tumukunde et al., 2015; Valtonen et al., 1989, Yau et al., 1991; Cakrtekin et al., 2015)
Country of Origin
The studies were carried out in one of the following countries: USA (Abboud et al., 1995); Italy (Capogna et al., 1991; Celleno et al., 1989; Celleno et al., 1993); Iran (Mamidi et al., 2011; Saharei et al., 2014; Tolyat et al., 2016); France (Dailland et al., 1989; Montandrau et al., 2019); China (Gin et al., 1993; Gregory et al., 1990; Yau et al., 1991); Malaysia (Miranda et al., 1992); England (Moore et al., 1991); Uganda (Tumukunde et al., 2015); Finland (Valtonen et al., 1989); Turkey (Cakrtekin et al., 2015).
Excluded Studies
Some studies, despite meeting the inclusion criteria, are not part of the review as the full work could not be obtained or the full text was in other languages ??despite the title and abstract being published in the selected languages ??of the review.
Risk of Bias of Included Studies
Figure 2 shows the risk of bias according to the Cochrane methodological bases. Regarding random sequence generation, allocation concealment, blinding of participants and staff, blinding of outcome assessment, selective reporting, and other risks, an unclear risk was mostly detected due to the absence or exposure of incomplete data in the publication work; The incomplete results data exposure parameter had a low risk of bias, since all the data that were operationalized were exposed as results. High risk of bias was only detected in the randomization of the groups, in which it was done by the number of medical records (Montandrau et al., 2019) and the presentation of incomplete data in the study results (Gregory et al., 1990). (Fig. 2).
Figure 2: Assessment of risk of bias
The independent quality assessment of each investigation is shown in the figure (Fig. 3).
Figure 3: Independent research quality assessment
The analysis of publication bias was carried out using the funnel plot for the variables: neonatal Apgar result 1 minute (Fig. 4), neonatal Apgar result 5 minutes (Fig. 5), neonatal result pH values ??(Figure 6), result neonatal pCO2 values ??(Fig. 7), neonatal pO2 values (Fig. 8).
Figure 4: Analysis of publication for the analysis of the Apgar neonatal 1 minute of life
Figure 5: Analysis of publication for the analysis of the Apgar neonatal 5 minute of life
Figure 6: Analysis of publication bias for the neonatal pH analysis
Figure 7: Analysis of publication bias for the neonatal pCO2 analysis
Figure 8: Analysis of publication bias for the neonatal pO2 analysis
Analysis of The Results
Neonatal Depression in The First Minute of Life
Seventeen studies reported data on neonatal depression within the first minute of life (Abboud et al., 1995; Capogna et al., 1991; Celleno et al., 1989; Celleno et al., 1993; Dailland et al., 1989; Gin et al., 1993; Gregory et al., 1990; Mamidi et al., 2011; Miranda et al., 1992; Montandrau et al., 2019; Moore et al., 1989; Saharei et al., 2014; Tolyat et al., 2016; Tumukunde et al., 2015; Valtonen et al., 1989, Yau et al., 1991; Cakrtekin et al., 2015)
The physical state of the newborns according to the Apgar scale at the first minute (Figure 9) showed a positive association between the study groups, with which it could be said that patients whose mothers were administered Propofol have a higher risk of present neonatal depression. (RR: 1.26; 95% CI: 1.07 and 1.48; patients 1898). The analysis of heterogeneity included chi2 values of 17.05 with df = 16 and the I2 value was 6% (low heterogeneity).
Figure 9: Forest graph for the analysis of neonatal Apgar at 1 minute of life
The GRADE approach was used to determine the level of evidence. In this case, a moderate level of evidence was obtained, especially due to the number of elements that assess the research risk that were classified as unclear risk (Table 2).
Neonatal Depression at Five Minutes of Life
Seventeen studies reported data on neonatal depression at five minutes of life (Abboud et al., 1995; Capogna et al., 1991; Celleno et al., 1989; Celleno et al., 1993; Dailland et al., 1989; Gin et al., 1993; Gregory et al., 1990; Mamidi et al., 2011; Miranda et al., 1992; Montandrau et al., 2019; Moore et al., 1989; Saharei et al., 2014; Tolyat et al., 2016; Tumukunde et al., 2015; Valtonen et al., 1989 ; Yau et al., 1991; Cakrtekin et al., 2015)
The physical state of the newborns according to the Apgar scale at five minutes of life (Fig. 10) showed that there were no significant differences between the experimental and the control group (RR: 1.22; 95% CI: 0.98 and 1.51; p = 0.07; participants: 1898 patients). The analysis of heterogeneity included chi2 values ??of 2.36 with df = 11 and the I2 value was 0% (homogeneous studies).
The GRADE approach was used to determine the level of evidence. In this case, a moderate level of evidence was obtained, especially due to the number of elements that assess the research risk that were classified as unclear risk. (Table 2)
Figure 10: Forest graph for the analysis of neonatal Apgar at 5 minute of life
Adaptive and Neurological Capacity
Seven studies assess adaptive and neurological capacity between the first 15 and 30 minutes, 2 hours and 24 hours of life (Abboud et al., 1995; Capogna et al., 1991; Celleno et al., 1993; Dailland et al., 1989; Gin et al., 1993; Gregory et al., 1990; Yau et al., 1991).
The adaptive and neurological capacity of newborns between 15 and 30 minutes, at 2 and 24 hours of life, shown in Figures 11-13, did not show significant differences between Propofol and Barbiturates (RR: 1.14; 0.88 and 0.96 respectively; 95% CI: 0.61 and 2.12; 0.42 and 1.84; 0.32 and 2.83 correspondingly; p = 0.68, 0.73 and 0, 94; participants: 281). Despite not finding a significant result, at 2 and 24 hours of life there was a lesser tendency to low adaptive and neurological capacity in the group whose mothers were administered Propofol. The analysis of heterogeneity included chi2 values ??of 3.90; 3.73 and 1.76, with df of 5; 5 and 4 respectively and the I2 values ??were 0% in the three results. (Homogeneous studies).
Figure 11: Forest graph for the analysis of neonatal adaptaive and neurological capacity at 15 minutes of life
Figure 12: Forest graph for the analysis of neonatal adaptaive and neurological capacity at 2 hours of life
Figure 13: Forest graph for the analysis of neonatal adaptaive and neurological capacity at 24 hours of life
Neonatal Acidosis
Between seven and nine investigations report data on neonatal acidosis status (Abboud et al., 1995; Capogna et al., 1991; Dailland et al., 1989; Gin et al., 1993; Montandrau et al., 2019; Moore et al., 1989; Valtonen et al., 1989; Yau et al., 1991; Cakrtekin et al., 2015).
In the evaluation of the acid-base status of the newborns for pH, pCO2, and HCO3 values ??at birth (Fig. 14-16), no statistical difference was observed between the treated and control groups. (SMD: 0.34, 0.96, 1.24, and -0.17 respectively; 95% CI: 0.98 and 0.31, 0.26 and 1.66, -0.06 and 2.53; and -0.97 and 0.62 correspondingly; p = 0.31, 0.06 and 0.66; participants: 753 patients).
Regarding the BE value (Fig. 17), if it was statistically significant (SMD: 0.96; 95% CI: 0.26-1.66; p = 0.007; participants: 344 patients), thus expressing a positive association between the comparison groups, and therefore, the infants in the experimental group have a higher risk of negative BE than the control group.
Figure 14: Forest graph for the neonatal pH analysis
Figure 15: Forest graph for the neonatal pCO2 analysis
Figure 16: Forest graph for the neonatal HCO3 analysis
The analysis of heterogeneity included chi2 values ??of 110.81; 51.26; 223.62 and 23.44, with df of 8; 6; 8 and 3 respectively and the I2 values ??were 93% for pH, 88% for BE, 96% for pCO2 and 87% for HCO3. (Considerably heterogeneous studies).
Figure 17: Forest graph for the neonatal BE analysis
The GRADE approach was used to determine the level of evidence. In this case, a moderate level of evidence was obtained, especially due to the number of elements that assess the research risk that were classified as unclear risk. (Table 2)
Neonatal Hypoxia
Nine studies reported data on neonatal depression in the first minute of life (Abboud et al., 1995; Capogna et al., 1991; Dailland et al., 1989; Gin et al., 1993; Montandrau et al., 2019; Moore et al., 1989; Valtonen et al., 1989; Yau et al., 1991; Cakrtekin et al., 2015).
As shown in Fig. 18, there were no statistical differences regarding the pO2 values ??of the newborns (SMD: -0.34, 95% CI: -0.98-0.31, p = 0.31; participants: 410 patients). The analysis of heterogeneity included chi2 values ??of 110.81 with df = 8 and the I2 value was 93% (considerable heterogeneity).
Figure 18: Forest graph for the neonatal pO2 analysis
The GRADE approach was used to determine the level of evidence. In this case, a moderate level of evidence was obtained, especially due to the number of elements that assess the research risk that were classified as unclear risk. (Table II)
Need for Admission to the NICU
Four studies reported the need for intensive care (Gin et al., 1993; Montandrau et al., 2019; Moore et al., 1989; Tumukunde et al., 2015)
According to the analysis of the need for admission to the neonatal intensive care unit (Fig. 19), it was found that there were no statistical differences between the two comparison groups (RR: 1.11; 95% CI: 0.49-2.54; p = 0.08; participants: 614 patients). The analysis of heterogeneity included chi2 values ??of 6.78 with df = 3 and the I2 value was 56% (moderate heterogeneity).
Figure 19: Forest graph according the need of neonatal admission in the Neonatal Intensive Care Unit
Tau2 values ??are also presented in each figure.
Discussion
The work that was carried out enables the synthesis of the scientific data available and evaluated the results of the use of Propofol as an anesthetic agent for the induction of general anesthesia in cesarean section compared to different barbiturates.
After data analysis, the deduction of fundamental elements in the subject in question is facilitated: that there were statistically significant differences in favor of the use of Barbiturates in the induction of anesthesia for cesarean section in terms of the physical state of the newborn at the first minute of life. There was no statistical difference according to the physical state of the newborn at five minutes, and the adaptive and neurological capacity between 15 and 30 minutes and at 2 and 24 hours. Also, there was a lack of evidence to support one or another drug with respect to the acid-base status of newborns, although an accurate analysis could not be performed due to the heterogeneity present in the investigations.
The search found that a systematic review was conducted in 2018 that evaluated the results comparing the use of Thiopental against Propofol, Ketamine and benzodiazepines as inducing anesthetic agents for cesarean section. The authors carried out a study of 18 controlled and randomized clinical trials involving 911 patients, where they found that induction resulted in significantly lower pO2 values ??than when it was performed with Thiopental (SMD: -11.52 [-17.60, -5.45] ; p = 0.0002). There were no significant differences in the analysis of other blood gases, or in terms of the Apgar score. (Houthoff Khemlani K et al., 2018)
Abboud et al., 1995; Capogna et al., 1991; Mamidi et al., 2011 and Montandrau et al., 2019, to name just a few studies, found no differences between the results of comparing Propofol and Barbiturates in the physical state of newborns, and consider Propofol an excellent alternative for anesthetic induction in this situation.
Regarding the adaptive capacity of newborns, investigations published by authors such as Dailland et al., 1989; Gin et al., 1993 and Yau et al., 1991, reported Propofol as a safe alternative with little impact on the newborn, without contributing differences with statistical significance.
Regarding the production of acidosis, no differences were found between Propofol and the Barbiturates used, according to the publications of Gin et al., 1993; Moore et al., 1989 and Valtonen et al., 1989, although the BE was higher in the group of Barbiturates , which results in the increased risk for this result.
And finally, the need for intensive care showed no difference between the study groups, although there was a slight increase in risk in patients whose mothers received Barbiturates, as shared by Gin et al., 1993; Montandrau et al., 2019; Moore et al., 1989 and Tumukunde et al., 2015.
The authors consider that the heterogeneity they observed between the studies was mainly due to the different types of measurement and evaluation with which the variables that respond to the acid-base status of the patients were analyzed, which made it difficult to combine the scientific evidence.
The sensitivity assessment that subtraction of the research with less weight in terms of quality did not change the primary outcome that was found.
The analysis of publication bias using the funnel plot showed skewness in the results that assessed the acid base status of the patients, which may be due to the number and small samples of the studies that were included in the review and the presence of heterogeneity. between investigations.
It is valid to note that when reviewing the anesthetic protocol of the studies that were included, the investigations that favored the control group used doses of Propofol higher than those recommended in the literature (Montandrau et al., 2019) or close to the upper limit of the therapeutic window (Celleno et al., 1989; Celleno et al., 1993; Valtonen et al., 1989), while the barbiturate drug doses were in the middle of the suggested dose range.
From a clinical point of view, it is known that Propofol has a greater negative impact than barbiturates, and despite the fact that its effect as a myocardial depressant has not been demonstrated, it does manifest considerable peripheral vasodilation due to a reduction in sympathetic activity and a reduction in blood pressure availability of calcium for contraction of vascular smooth muscle (Vuyk J et al., 2020) This hypotension could put at risk the blood perfusion of the uterus, which is completely dependent on the systemic cardiac output, as it is of high flow and low resistance. This relevant aspect could be prevented by reducing the dose to be used of Propofol, with an adequate preoperative vascular filling, increasing the availability of calcium and the preventive use of vasoconstrictors. In addition, performing laryngoscopy triggers a sympathomimetic stimulus, which could counteract the depressant effects of Propofol.
Among the limitations of the current systematic review and meta-analysis, is the exclusion of several studies due to not having the full text, the limitation of the search languages, and the heterogeneity that occurred in several results, without having a sufficient number of studies to carry out meta-regression analysis. It is valid to point out that the databases where the searches were carried out contain most of the scientific publications in the world, and that the quality of the review makes it possible to implement the knowledge in clinical practice. On the other hand, it is believed necessary to carry out a controlled and randomized clinical trial to strengthen this evidence in Cuba.
Conclusion
The use of Propofol for anesthetic induction in cesarean section is a good alternative with little impact on the physical state at five minutes since there was greater depression at one minute of life with the use of this; and the adaptive and neurological capacity of the newborn, the production of acidosis and the need for neonatal intensive care. Therefore, its use is recommended to perform anesthetic induction of patients who arrive for elective cesarean section surgery.
Recommendations
Carry out a clinical trial with the purpose of demonstrating the effectiveness of the use of propofol as an inducing agent in elective caesarean section with respect to neonatal outcomes.
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links:
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