[Hemodynamic, immunologic and systemic stress response during surgery under total intravenous anesthesia with midazolam-ketamine-fentanyl or remifentanil-midazolam: a randomized clinical trial]. / Estudio comparativo de anestesia total intravenosa con midazolam- ketamina-fentanilo y remifentanilo-midazolam: evaluación de la respuesta hemodinámica, leucocitaria y de los marcadores sistémicos de estrés.

OBJECTIVE: To assess the effect of stress from surgery on hemodynamics, white cell count, and systemic markers during cholecystectomies performed under 2 intravenous anesthetic techniques. PATIENTS AND METHOD: Randomized clinical trial in patients classified ASA 1 or 2. The patients received 0.15 mg x kg(-1) of midazolam, 1 mg x kg(-1) x h(-1) of ketamine, and 2 microg x kg(-1) of fentanyl (MKF group) or 1 microg x kg(-1) x min of remifentanil and 0.15 mg x kg(-1) of midazolam (RM group). Hemodynamic parameters, white cell counts in circulating blood, and serum levels of cortisol, prolactin, and interleukin-6 were recorded before surgery, after intubation, and at the end of surgery. RESULTS: Thirty-two patients were enrolled. Hemodynamic stability was good in both groups. After intubation, mean (SD) heart rate (75 [14] beats x min(-1)) and systolic (96 [14] mm Hg) and diastolic (60 [7] mm Hg) blood pressures were lower in the RM group than in the MKF group (99 [17] beats x min(-1); 121 [29] mm Hg; and 79 [14] mm Hg, respectively, P<0.01). After surgery whi- te cell (10528 [6480] microL(-1)) and neutrophil (8155 [5657] microL(-1)) counts and cortisol concentration (225 [257] ng x mL(-1)) were significantly lower in the RM patients than in the MKF patients (white cell count, 14,002 [5927] cells x micromL(-1); neutrophil count, 11530 [5657] cells x microL(-1), and 788.8 [146] ng x mL(-1); P<0.01). CONCLUSIONS: The 2 intravenous anesthesia regimens compared differ slightly with regard to their effects on surgical stress. Anesthesia with remifentanil and midazolam contributes to reducing the inflammatory response through modulation of the neurohumoral response to stress.

Estudio comparativo de anestesia total intravenosa con midazolamketamina- fentanilo y remifentanilo-midazolam: evaluación de la respuesta hemodinámica, leucocitaria y de los marcadores sistémicos de estrés / Hemodynamic, immunologic and systemic stress response during surgery under total intravenous anesthesia with midazolamketamine-fentanyl or remifentanilmidazolam: a randomized clinical trial

OBJETIVO: Evaluar el estrés anestésico quirúrgico,durante colecistectomías realizadas con dos regímenesde anestesia intravenosa, observando la respuesta hemodinámica,leucocitaria y de los marcadores sistémicos deestrés.MATERIAL Y MÉTODO: Estudio clínico prospectivo randomizadoen pacientes ASA I-II. Los pacientes recibieronmidazolam 0,15 mg Kg-1, ketamina 1 mg Kg-1 h-1 y fentanilo2 µg Kg-1 (grupo MKF) o remifentanilo 1 µg Kg-1 miny midazolam 0,15 mg Kg-1 (grupo RM). Se evaluaronvariables hemodinámicas, recuentos leucocitarios en sangreperiférica y niveles séricos de cortisol, prolactina einterleucina-6, que fueron registrados antes de la cirugía,después de la intubación y al final de la cirugía.RESULTADOS: Se incluyeron treinta y dos pacientes.Ambos grupos mostraron buen control hemodinámico.Después de la intubación, en el grupo RM la frecuenciacardiaca (75±14 latidos min-1) y la presión arterial sistólica(96±14 mm Hg) y diastólica (60±7 mm Hg) fueroninferiores a las del grupo MKF (99±17 latidos min-1,121±29 mm Hg y 79±14 mm Hg, respectivamente,p<0,01). Al final de la cirugía se verificó un nivel de leucocitos(10528±6480 mL-1), neutrófilos (8155±5657 mL-1 )y de cortisol (225±257 ng mL-1) significativamente menoresen los pacientes RM, comparados con los pacientesMKF (14002±5927 leucocitos mL-1, 11530±5657 neutrófilosmL-1 y 788,8±146 ng mL-1, respectivamente, p<0,01).CONCLUSIONES: Los regímenes de anestesia intravenosaevaluados difieren escasamente en sus efectos sobre larespuesta de estrés a la cirugía. La anestesia con remifentanilo-midazolam contribuye a disminuir la respuestainflamatoria al modular la respuesta neurohumoral deestrés

OBJECTIVE: To assess the effect of stress from surgeryon hemodynamics, white cell count, and systemic markersduring cholecystectomies performed under 2 intravenousanesthetic techniques.PATIENTS AND METHOD: Randomized clinical trial inpatients classified ASA 1 or 2. The patients received 0.15mg·kg-1 of midazolam, 1 mg·kg-1·h-1 of ketamine, and 2µg·kg-1 of fentanyl (MKF group) or 1 µg·kg-1·min of remifentaniland 0.15 mg·kg-1 of midazolam (RM group).Hemodynamic parameters, white cell counts in circulatingblood, and serum levels of cortisol, prolactin, andinterleukin-6 were recorded before surgery, after intubation,and at the end of surgery.RESULTS: Thirty-two patients were enrolled. Hemodynamicstability was good in both groups. After intubation,mean (SD) heart rate (75 [14] beats·min-1) and systolic(96 [14] mm Hg) and diastolic (60 [7] mm Hg) bloodpressures were lower in the RM group than in theMKF group (99 [17] beats·min-1; 121 [29] mm Hg; and79 [14] mm Hg, respectively, P<0.01). After surgery whimistecell (10528 [6480] µL-1) and neutrophil (8155 [5657]µL-1 ) counts and cortisol concentration (225 [257]ng·mL-1) were significantly lower in the RM patientsthan in the MKF patients (white cell count, 14 002[5927] cells·µmL-1; neutrophil count, 11530 [5657]cells·µL-1, and 788.8 [146] ng·mL-1; P<0.01).CONCLUSIONS: The 2 intravenous anesthesia regimenscompared differ slightly with regard to their effects on surgicalstress. Anesthesia with remifentanil and midazolamcontributes to reducing the inflammatory response throughmodulation of the neurohumoral response to stress