title: [Hemodynamic, immunologic and systemic stress response during surgery under total intravenous anesthesia with midazolam-ketamine-fentanyl or remifentanil-midazolam: a randomized clinical trial].
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Departamento de Anestesiología e Instituto de Inmunología, Facultad de Ciencias Médicas y Carrera del Investigador del Consejo de Investigaciones, Universidad Nacional de Rosario, República Argentina.
authors.forename: G A
authors.initials: GA
authors.lastname: Elena
authors.forename: A P
authors.initials: AP
authors.lastname: Acosta
authors.forename: S
authors.initials: S
authors.lastname: Antoniazzi
authors.forename: V
authors.initials: V
authors.lastname: Tettamanti
authors.forename: F
authors.initials: F
authors.lastname: Méndez
authors.forename: D
authors.initials: D
authors.lastname: Colucci
authors.forename: N R
authors.initials: NR
authors.lastname: Puig
mesh_terms: D000328:Adult; D000368:Aged; D000771:Anesthesia, Intravenous; D019162:Anesthetics, Combined / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D005260:Female; D005283:Fentanyl / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007107:Immune System / Q000187:drug effects; D007649:Ketamine / Q000494:pharmacology*; D008297:Male; D008874:Midazolam / Q000494:pharmacology*; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology*; D000077208:Remifentanil; D013312:Stress, Physiological / Q000097:blood* / Q000139:chemically induced* / Q000276:immunology
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D010880:Piperidines; D007649:Ketamine; D000077208:Remifentanil; D008874:Midazolam; D005283:Fentanyl