Comparison of the safety of alfaxalone and propofol as anaesthetic induction agents in bitches undergoing c-section

  • Benjamin Haythornthwaite University of Cambridge



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PICO question

In bitches and their puppies undergoing caesarean section, is an alfaxalone or a propofol induction safer?


Clinical bottom line

Category of research question


The number and type of study designs reviewed

Six papers were critically reviewed. There were two randomised controlled trials directly comparing alfaxalone and propofol inductions, two randomised controlled trials including a propofol induction in one of the experimental groups and two non-comparative studies.

Strength of evidence


Outcomes reported

Propofol and alfaxalone can both be used safely for the anaesthesia of bitches and their puppies undergoing caesarean section. There is evidence that alfaxalone may provide better anaesthesia quality for the bitches, and the puppies may be delivered with higher indicators of puppy vitality following its use. Further research into the beneficial clinical outcomes of alfaxalone should be investigated.


The use of both propofol and alfaxalone for the induction of bitches undergoing caesarean section can be recommended.


How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.


Open Access Peer Reviewed


Batista, M., Moreno, C., Vilar, J., Golding, M., Brito, C., Santana, M. and Alamo, D. (2014). Neonatal viability evaluation by Apgar score in puppies delivered by cesarean section in two brachycephalic breeds (English and French bulldog). Animal Reproduction Science, 146(3–4):218–226. DOI:

De Cramer, K.G.M., Joubert, K.E. and Nöthling, J.O. (2017). Puppy survival and vigor associated with the use of low dose medetomidine premedication, propofol induction and maintenance of anesthesia using sevoflurane gas-inhalation for cesarean section in the bitch. Theriogenology, 96:10–15. DOI:

Doebeli, A., Michel, E., Bettschart, R., Hartnack, S. and Reichler, I.M. (2013). Apgar score after induction of anesthesia for canine cesarean section with alfaxalone versus propofol. Theriogenology, 80(8):850–854. DOI:

Funkquist, P.M., Nyman, G.C., Löfgren, A.J. and Fahlbrink, E.M. (1997). Use of propofol-isoflurane as an anesthetic regimen for cesarean section in dogs. Journal of the American Veterinary Medical Association, 211(3):313–317.

Gaynor, J.S., Dunlop, C.I., Wagner, A.E., Wertz, E.M., Golden, A.E. and Demme, W.C. (1999). Complications and mortality associated with anesthesia in dogs and cats. Journal of the American Animal Hospital Association, 35(1):13–17. DOI:

Ko, J.C., Nicklin, C.F., Melendaz, M., Hamilton, P. and Kuonen, C.D. (1998). Effects of a microdose of medetomidine on diazepam-ketamine induced anesthesia in dogs. Journal of the American Veterinary Medical Association, 213(2):215–219.

Luna, S.P.L., Cassu, R.N., Castro, G.B., Neto, F.T., Silva, J.R. and Lopes, M.D., 2004. Effects of four anaesthetic protocols on the neurological and cardiorespiratory variables of puppies born by caesarean section. Veterinary Record, 154(13), pp.387-389. DOI:

Metcalfe, S., Hulands‐Nave, A., Bell, M., Kidd, C., Pasloske, K., O'hagan, B., Perkins, N. and Whittem, T. (2014). Multicentre, randomised clinical trial evaluating the efficacy and safety of alfaxalone administered to bitches for induction of anaesthesia prior to caesarean section. Australian Veterinary Journal, 92(9):333–338. DOI:

Moon, P.F., Erb, H.N., Ludders, J.W., Gleed, R.D. and Pascoe, P.J. (1998). Perioperative management and mortality rates of dogs undergoing cesarean section in the United States and Canada. Journal of the American Veterinary Medical Association, 213(3):365–369.

Sánchez‐Alcaraz, A., Quintana, M.B. and Laguarda, M. (1998). Placental transfer and neonatal effects of propofol in caesarean section. Journal of Clinical Pharmacy and Therapeutics, 23(1):19–23. DOI:

Silva, L.C.G., Lucio, C.F., Veiga, G.A.L., Rodrigues, J.A. and Vannucchi, C.I. (2009). Neonatal clinical evaluation, blood gas and radiographic assessment after normal birth, vaginal dystocia or caesarean section in dogs. Reproduction in Domestic Animals, 44:160–163. DOI:

Veronesi, M.C., Panzani, S., Faustini, M. and Rota, A. (2009). An Apgar scoring system for routine assessment of newborn puppy viability and short-term survival prognosis. Theriogenology, 72(3):401–407. DOI:

Vilar, J.M., Batista, M., Pérez, R., Zagorskaia, A., Jouanisson, E., Díaz-Bertrana, L. and Rosales, S. (2018). Comparison of 3 anesthetic protocols for the elective cesarean-section in the dog: Effects on the bitch and the newborn puppies. Animal Reproduction Science, 190:53–62. DOI:

Vol. 5 No. 3 (2020): The third issue of 2020

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  / 

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