Department of Anesthesia and Pain Management, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Anesthesia and Critical Care, University Hospital of Würzburg, Würzburg, Germany.
J Clin Anesth. 2018 Aug;48:73-80. doi: 10.1016/j.jclinane.2018.04.010. Epub 2018 May 26.
An ideal induction drug for cesarean section (CS) must have quick action, with minimum side effects such as awareness, hemodynamic compromise, and neonatal depression. Thiopentone is frequently used; however, no reliable evidence is available to support its use as a dedicated hypnotic agent in this setting.
A systematic review and meta-analysis, using PRISMA methodology, of randomized controlled trials (RCTs), comparing women undergoing CS using thiopentone with those undergoing CS with propofol, ketamine, or benzodiazepines as hypnotic agents.
Comprehensive search without language restrictions of MEDLINE, EMBASE, and the Cochrane Controlled Trials Registers until May 2015, with an update in January 2017. Included trials must have reported at least one of the following variables: neonatal arterial or venous umbilical blood gas, maternal systolic blood pressure pre- and post-intubation, or Apgar score.
A total of 911 patients from 18 RCTs were eligible for quantitative analysis. The increase in maternal systolic blood pressure was smaller in patients administered propofol, compared with those administered thiopentone (weighted mean difference [WMD]: -11.52 [-17.60, -5.45]; p = 0.0002). Induction with propofol also resulted in a significantly lower umbilical arterial pO (WMD: -0.12 [-0.20, -0.04]; p = 0.004) than induction with thiopentone. A comparison between propofol and thiopentone revealed no significant differences in other umbilical blood gas parameters or in Apgar scores. In contrast, when comparing ketamine with thiopentone, the number of neonates with a lower Apgar score (<7) at 1 and 5 min was significantly higher in the ketamine group than in the thiopentone group (p = 0.004).
The evidence, based on sparse and relatively old trials, indicates that propofol and thiopentone are equally suited for CS. After 1 and 5 min, ketamine yields lower Apgar scores than thiopentone. Additional well-designed trials are needed to reach firmer conclusions.
剖宫产（CS）理想的诱导药物必须起效迅速，且副作用小，如意识、血流动力学受损和新生儿抑郁。硫喷妥钠常用于剖宫产诱导，但尚无可靠证据支持其作为专用催眠药物在这种情况下使用。
采用 PRISMA 方法对比较使用硫喷妥钠与使用丙泊酚、氯胺酮或苯二氮䓬类药物作为催眠药物行剖宫产的随机对照试验（RCT）进行系统评价和荟萃分析。
对 MEDLINE、EMBASE 和 Cochrane 对照试验注册库进行全面检索，无语言限制，检索截至 2015 年 5 月，2017 年 1 月更新。纳入的试验必须至少报告以下变量之一：新生儿动脉或静脉脐血血气、插管前和插管后产妇收缩压或 Apgar 评分。
共纳入 18 项 RCT 的 911 名患者进行定量分析。与硫喷妥钠相比，丙泊酚组产妇收缩压升高幅度较小（加权均数差[WMD]：-11.52[-17.60，-5.45]；p=0.0002）。与硫喷妥钠相比，诱导使用丙泊酚也可使脐动脉 pO2 显著降低（WMD：-0.12[-0.20，-0.04]；p=0.004）。丙泊酚与硫喷妥钠比较显示，其他脐血血气参数或 Apgar 评分无显著差异。相比之下，当比较氯胺酮与硫喷妥钠时，氯胺酮组新生儿在 1 分钟和 5 分钟时 Apgar 评分<7 的比例明显高于硫喷妥钠组（p=0.004）。
基于相对较少且较为陈旧的试验证据表明，丙泊酚和硫喷妥钠在 CS 中同样适用。与硫喷妥钠相比，氯胺酮在 1 分钟和 5 分钟时产生的 Apgar 评分较低。需要更多设计良好的试验来得出更确定的结论。
