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Is propofol A suitable choice for Cesarean delivery
Abstract Number: T-24
Abstract Type: Original Research
Is Propofol a Suitable Alternative to Thiopental for Cesarean Section?
With recent drug shortage, propofol has emerged as the front line induction agent for cesarean delivery. However, controversies exist regarding its use for induction in the obstetrical population (ref-1). Previous studies pointed that propofol is associated with neonatal depression, possibly awareness compared to thiopental (ref 2-3-4). We therefore conducted this systematic review to seek whether propofol is a suitable choice for cesarean section as compared to thiopental
Randomized controlled trials comparing propofol to thiopental for cesarean section were searched and reviewed. Apgar scores, neonatal neurobehavioral scoring, hemodynamic variables, induction to delivery interval, cord blood gases, awareness, and reported sides effects were collected. All articles were scored for validity; available data were extracted and subsequently analyzed using relative risk ratio [RR]; odd ratio [CI] with 95% confidence interval [CI].
Fifteen independent trials were identified; two trials were presented in abstract format. One trial was excluded because of duplicate results. The remainder 14 studies were included in this analysis. Apgar scores, induction to delivery interval, umbilical artery pH was reported with enough regularity and uniformity to allow for comprehensive analysis. We found that propofol results in neonatal depression as assessed by Apgar scores superior > to 7 at 1 min compared with thiopental (fig1). This difference was not seen when considering Apgar scores > 7 at 5 min (fig 2).There was no difference in UA pH between propofol and thiopental,however that I-D time was faster for propofol group.
The use of propofol is associated with neonatal depression as measured with 1 min Apgar. This effect was not seen at 5 min. However neonatal neurobehavioral scores were lower with propofol use. Awareness could be a potential problem in the future if an adequate dose is not used. We therefore suggest that propofol may not be an ideal choice for induction of anesthesia during cesarean delivery.
1- Russell R: controversy in obstetric anesthesia IJOA 2003- 12
2- Dailland P: Anesthesiology 1989
3- Celleno D: J clinical anesthesia
4- Capogna G:IOJA 1991.