Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis☆
Received 14 May 2007; received in revised form 27 September 2008; accepted 7 October 2008. published online 29 June 2009.
Abstract
Study 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]-α) and IAP.
Design
Prospective, single-center study.
Setting
University hospital.
Patients
40 adult ICU patients who had undergone ileus surgery and who were expected to require postoperative sedation and ventilation.
Interventions
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 μg/kg over 10 minutes followed by a maintenance dose of 0.2-2.5 μg/kg/h (n = 20, Group D) at the 24th hour.
Measurements
Biochemical and hemodynamic parameters, cytokine levels, and IAP were recorded before the start of the study and at the 24th and 48th hours.
Main Results
TNF-α 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.
Conclusion
Dexmedetomidine infusion decreases TNF-a, IL-1, and IL-6 levels and IAP more than a propofol infusion.
ABSTRACT