Cerebral Microdialysis Effects of Propofol versus Midazolam in Severe Traumatic Brain Injury

Abstract

Propofol, an anesthetic agent acting as an analogue of vitamin E, has been advocated to be an ideal neuroprotective agent both in animal models and in clinical practice, due to its positive effects on oxidative stress. Nevertheless, no studies have compared this agent to another sedative agent used for sedation after traumatic brain injury (TBI). The objective was to compare the effects of propofol to midazolam on cerebral biomarkers at the acute phase of severe TBI patients. Thirty patients aged 35±18 years were prospectively randomized to receive propofol or midazolam and 29 were analyzed (n=15 for propofol, and n=14 for midazolam). A cerebral microdialysis catheter was used to measure the lactate:pyruvate (L:P) ratio, glutamate, glycerol, and glucose for 72 h. No difference between groups was observed for the L:P ratio (time effect p=0.201, treatment effect p=0.401, time×treatment interaction p=0.101). Similarly, no difference was observed for glutamate (time effect p=0.930, treatment effect p=0.651, time×treatment interaction p=0.353), glycerol (time effect p=0.223, treatment effect p=0.922, time×treatment interaction p=0.308), or glucose (time effect p=0.116, treatment effect p=0.088, time×treatment interaction p=0.235). These results do not support a difference between propofol and midazolam for sedation for the cerebral metabolic profile in severe TBI.

Sedation in Traumatic Brain Injury

“…Propofol may act as a neuroprotective agent through limitation of oxidative stress. An RCT employing cerebral microdialysis catheters compared sedation with midazolam and propofol, using several cerebral biomarkers as endpoints in the acute phase of TBI [13]. No difference was found between the two groups over a 72-hour period in the lactate to pyruvate ratio, a marker of cerebral oxidative stress.…”

IPAD: the Integrated Pathway Analysis Database for Systematic Enrichment Analysis

“…They show strong links with brain, such as 1) Clobazam [43], 2) Chlordiazepoxide [44], 3) Midazolam [45], 4) Flurazepam [46], 5) Oxazepam [47], 6) Bromazepam [48], and 7) Nitrazepam [49]. …”

Remifentanil up2date – Teil 2

“…Respiratorische Vorerkrankungen wie die chronisch obstruktive Lungenerkrankung (COPD), das Lungenemphysem, das obstruktive Schlafapnoe-Syndrom (OSAS) sowie das Asthma sind bei Patienten weitverbreitet. Opioidinduzierte respiratorische Probleme treten meistens innerhalb der ersten postoperativen 24 Stunden auf [24]. Die Empfehlung, bei diesen Patienten neuroaxiale und regionalanästhesiologische Verfahren vorzuziehen, ist nicht immer anwendbar (z.…”