Effect of midazolam and propofol on cytokine balance in patients undergoing cardiac valve replacement

Objective To compare the effect of midazolam and propofol on cytokine balance in patients undergoing cardiac June 2003 Vol12 No2 valve replacement under CPB. Methods Twenty NYHA class II - 333 patients with rheumatic heart disease scheduled for elective cardiac valve replacement under CPB were randomy divided into 2 groups: midazolam group (M, n = 10) and propofol group (P, n = 10). Patients with preoperative hepatic and renal dysfunctions were premedicated intramuscular morphine 0. 1 mg · kg-1 and oral diazepam 0.1 mg·kg-1 . Anesthesia was induced withmidazolam 0. 06 -0.1 mg· kg-1 (group M) or propofol1.0-1.5 mg·kg-1 (gropu P) and scopolamine 0.6 mg, fentanyl 4-10 μg · kg-1, vecuronium 0. 1 mg · kg-1 and lidocaine 1. 5 mg·kg-1,and maintained with intermittent iv boluses of midazolam 0. 04 - 0.1 mg· kg-1(group M) or propofol intravenous infusion at a rate of 3 - 5 mg· kg-1 · h-1 supplemented with intermittent boluses of fentanyl and vecuronium. PETCO2 was maintained at 30 -40 mmHg during

Objective To compare the effect of midazolam and propofol on cytokine balance in patients undergoing cardiac June 2003 Vol12 No2 valve replacement under CPB. Methods Twenty NYHA class II - 333 patients with rheumatic heart disease scheduled for elective cardiac valve replacement under CPB were randomy divided into 2 groups: midazolam group (M, n = 10) and propofol group (P, n = 10). Patients with preoperative hepatic and renal dysfunctions were premedicated intramuscular morphine 0. 1 mg · kg-1 and oral diazepam 0.1 mg·kg-1 . Anesthesia was induced with midazolam 0. 06 -0.1 mg· kg-1 (group M) or propofol 1.0-1.5 mg·kg-1 (gropu P) and scopolamine 0.6 mg, fentanyl 4-10 μg · kg-1, vecuronium 0. 1 mg · kg-1 and lidocaine 1. 5 mg·kg-1,and maintained with intermittent iv boluses of midazolam 0. 04 - 0.1 mg· kg-1(group M) or propofol intravenous infusion at a rate of 3 - 5 mg· kg-1 · h-1 supplemented with intermittent boluses of fentanyl and vecuronium. PETCO2 was maintained at 30 -40 mmHg during mechanical ventilation. BP,HR,ECG, CVP, PETCO2, SpO2, nasal and rectal temperature were continuously monitored during operation. Blood samples were taken from artery before anesthesia (T1), at vena cava catheterization (T2), 30 min after aortic cross-clamping (T3) and 10 min (T4),1 h (T5),2 h(T6),4 h (T7) and 24 h (T8) after declamping of aorta for determination of Hct, IL - 1, IL - 8 and IL - 10 by using ELISA. Results Plasma concentration of IL - 6, IL - 8 and IL - 10 were significantly increased at T4-7 as compared with the baseline value before anesthesia (T1) in both group. Plasma concentration of IL - 8 in group P was significantly lower than that in group M at T7 ( P < 0.05). The plasma level of IL - 10 in group M were significantly lower than those in group P at T4-6(P< 0.05 or 0.01). Conclusion In our study IL- 6, IL- 8 and IL - 10 increase significantly during operation in both groups and all patients recovered uneventfully. Propofol has more profound effect on cytokine response to surgery than midazolam but a balance between pro - and antiinflammatory cytokines is well maintained during operation. 14 refs,3 tabs.