Assessing Neonatal Apgar Scores Following Propofol and Thiopental Induction in Cesarean Sections: A Systematic Review.

Propofol and thiopental are commonly used induction agents for general anesthesia in cesarean sections. While both are effective, their impact on neonatal outcomes, particularly Apgar scores, remains a subject of clinical interest. Neonatal Apgar scores are critical indicators of early adaptation and are used to assess the immediate well-being of the newborn after delivery. This meta-analysis aimed to compare the effects of propofol and thiopental on neonatal Apgar scores at five minutes following cesarean delivery under general anesthesia. A systematic literature search was performed in PubMed, Embase, Cochrane CENTRAL, and Web of Science for studies published up to 2025. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were randomized controlled trials or comparative studies that evaluated pregnant women undergoing cesarean section under general anesthesia, comparing propofol versus thiopental for induction, and reporting neonatal Apgar scores at five minutes. Exclusion criteria included studies with incomplete data, non-comparative designs, or lacking Apgar score reporting. Data were extracted and analyzed using a random-effects model. The primary outcome was the incidence of low Apgar scores (< 7) at five minutes. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using I², τ², and χ² statistics. Five studies comprising 657 participants (propofol: n = 506; thiopental: n = 494) met the inclusion criteria. The pooled OR for low Apgar scores at five minutes was 0.93 (95%CI: 0.58-1.49; p = 0.76), indicating no statistically significant difference between the two agents. Heterogeneity was low to moderate (τ² = 0.05; χ² = 5.42; df = 4; p = 0.25; I² = 26%). All included studies were at low risk of bias. These findings suggest that both agents are comparably safe for neonatal outcomes at five minutes and can be considered clinically acceptable options for induction in obstetric anesthesia. However, clinicians should consider individual patient contexts and institutional protocols when choosing between the agents. Further large-scale studies are recommended to assess other neonatal and maternal outcomes.