Continuous midazolam infusion can minimize the pro-inflammatory response to anesthesia and surgery for pediatric patients with intra-abdominal infection: Comparative study versus continuous propofol infusion

Abstract

ABSTRACT Objectives : Comparison of serum levels of interleukin (IL)-1β, IL-6 and tumor necrosis factor-α (TNF-α) estimated before and after propofol or midazolam infusion during emergency surgery for children had intraabdominal infection (IAI) Patients & Methods : 140 children were allocated into Group P: included patients received propofol at the rate of 11 mg/kg/hr and Group M included patients received midazolam infusion at the rate of 0.3 mg/kg/hr. Anesthesia was induced with intravenous (IV) thiopentone (5 mg/kg) and maintained with 50% air in oxygen and an end-tidal concentration of 2–3% sevoflurane with IV rocuronium (0.6 mg/kg) and IV injection of paracetamol (10 mg/kg) as intraoperative analgesia. Study infusions were started before skin incision and stopped after skin closure. Blood samples were obtained before the start and at end of infusion for ELISA estimation of serum IL-1β, IL-6 and TNF-α levels. Study outcome is the effect of the study drugs on estimated serum cytokines’ levels. Results At the end of propofol infusion, serum cytokines’ levels were significantly higher in comparison to levels estimated before start of infusion. while, at the end of midazolam infusion, serum cytokines’ levels were significantly decreased in comparison to levels estimated before the start of infusion. Conclusion Midazolam infusion not propofol infusion decreased serum cytokines’ levels and could modulate the preexisting proinflammatory status of pediatric patients with IAI and prevent the immune stress of anesthesia and surgery.