Effect of midazolam and propofol on cytokine balance in patients undergoing cardiac valve replacement / 中华麻醉学杂志

ABSTRACT

Objective To compare the effect of midazolam and propofol on cytokine balance in patients undergoing cardiac valve replacement under CPB. Methods Twenty NYHA class Ⅱ - Ⅲ patients with rheumatic heart disease scheduled for elective cardiac valve replacement under CPB were randomly divided into 2 groups midazolam group (M, n = 10) and propofol group (P, n = 10) . Patients with preoperative hepatic and renal dysfunction, coagulation defect and diabetes, primary hypertension and coronary artery disease were excluded. The patients 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 (group P) and scopolamine 0.6 mg, fentanyl 4-10 ug?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 mm Hg 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), 30min 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 concentrations 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