Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis.
OBJECTIVE
To compare the effects of an intravenous infusion of propofol and the alpha-2 adrenoceptor, dexmedetomidine, on inflammatory responses and intraabdominal pressure (IAP) in severe sepsis after abdominal surgery, specifically, serum cytokine levels (interleukin [IL]-1, IL-6, and tumor necrosis factor [TNF]-alpha) and IAP.


METHODS
Prospective, single-center study.


METHODS
University hospital.


METHODS
40 adult ICU patients who had undergone ileus surgery and who were expected to require postoperative sedation and ventilation.


METHODS
Patients received either a loading dose infusion of propofol (Group P; n = 20) one mg/kg over 15 minutes followed by a maintenance dose of one to three mg/kg/hr (n = 20, Group P) or a loading dose of dexmedetomidine of one microg/kg over 10 minutes followed by a maintenance dose of 0.2-2.5 microg/kg/h (n = 20, Group D) at the 24th hour.


METHODS
Biochemical and hemodynamic parameters, cytokine levels, and IAP were recorded before the start of the study and at the 24th and 48th hours.


RESULTS
TNF-alpha levels were significantly lower at the 24th hour (14.66 +/- 4.40 pg/mL vs. 21.21 +/- 11.37 pg/mL, respectively) and at the 48th hour (21.25 +/- 15.85 pg/mL vs. 46.55 +/- 35.99 pg/mL, respectively) in Group D. IL-1 levels were significantly lower at the 24th hour (5.03 +/- 0.15 pg/mL vs. 6.23 +/- 2.09 pg/mL, respectively) and the 48th hour (5.01 +/- 0.37 pg/mL vs. 6.42 +/- 2.76 pg/mL, respectively) in Group D. IL-6 levels were significantly lower at the 24th hour (253.1 +/- 303.6 pg/mL and 511.3 +/- 374.8 pg/mL, respectively) and at the 48th hour (343.5 +/- 393.4 pg/mL and 503.7 +/- 306.4 pg/mL, respectively) in Group D. Intraabdominal pressure also was significantly lower at the 24th hour (12.35 +/- 5.84 mmHg vs. 18.1 +/- 2.84 mmHg, respectively) and the 48th hour (13.9 +/- 6.15 mmHg vs. 18.7 +/- 3.46 mmHg, respectively) in Group D.


CONCLUSIONS
Dexmedetomidine infusion decreases TNF-a, IL-1, and IL-6 levels and IAP more than a propofol infusion.
Tasdogan
Muhittin
M
Department of Anaesthesiology and Reanimation, Trakya University Medical Faculty, 22030 Edirne, Turkey.
Memis
Dilek
D
Sut
Necdet
N
Yuksel
Mahmut
M
D000005:Abdomen / Q000601:surgery; D000316:Adrenergic alpha-Agonists / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D020927:Dexmedetomidine / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology* / Q000627:therapeutic use; D007249:Inflammation / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D007262:Infusions, Intravenous; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011312:Pressure; D015742:Propofol / Q000494:pharmacology* / Q000627:therapeutic use; D011446:Prospective Studies; D012121:Respiration, Artificial; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000187:drug effects; D055815:Young Adult
D000316:Adrenergic alpha-Agonists; D006993:Hypnotics and Sedatives; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D020927:Dexmedetomidine; D015742:Propofol