Effect of midazolam versus propofol sedation on markers of neurological injury and outcome after isolated severe head injury: a pilot study.

Hdl Handle:
http://hdl.handle.net/10147/209279
Title:
Effect of midazolam versus propofol sedation on markers of neurological injury and outcome after isolated severe head injury: a pilot study.
Authors:
Ghori, Kamran A; Harmon, Dominic C; Elashaal, Abdurrahim; Butler, Mark; Walsh, Fergus; O'Sullivan, Michael G J; Shorten, George D
Affiliation:
Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Ireland. kamrang@hotmail.com
Citation:
Crit Care Resusc. 2007 Jun;9(2):166-71.
Journal:
Critical care and resuscitation : journal of the Australasian Academy of Critical, Care Medicine
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/209279
PubMed ID:
17536986
Abstract:
BACKGROUND: Midazolam and propofol are sedative agents commonly administered to patients with brain injury. We compared plasma concentrations of glial cell S100beta protein and nitric oxide (NO) between patients who received midazolam and those who received propofol sedation after severe brain injury, and investigated the association between S100beta and NO concentrations and neurological outcome. DESIGN: 28 patients with severe head injury (Glasgow Coma Score <9) who required sedation and ventilation were randomly assigned to receive midazolam (n =15) or propofol (n = 13) based sedation. Blood samples were drawn daily for 5 days for estimation of S100beta and NO concentrations. Neurological outcome was assessed 3 months later as good (Glasgow Outcome Score [GOS], 4-5) or poor (GOS, 1-3). RESULTS: A good neurological outcome was observed in 8/15 patients (53%) in the midazolam group and 7/13 patients (54%) in the propofol group. Patients with a poor outcome had higher serum S100beta concentrations on ICU admission and on Days 1-4 in the ICU than those with a good outcome (mean [SD] on Day 1, 0.99 [0.81] v 0.41 [0.4] microg/L; Day 2, 0.80 [0.81] v 0.41 [0.24] microg/L; Day 3, 0.52 [0.55] v 0.24 [0.25] microg/L; and Day 4, 0.54 [0.43] v 0.24 [0.35] microg/L; P<0.05). There was no significant difference on Day 5. Plasma NO concentrations were not associated with outcome. In subgroup analysis, there was no difference in S100beta and NO concentrations between patients with a good outcome versus those with a poor outcome in either the midazolam or propofol group. CONCLUSIONS: Plasma concentrations of markers of neurological injury in patients with severe head injury were similar in those who received midazolam sedation and those who received propofol. Patients who had a poor neurological outcome at 3 months had consistently higher serum S100beta concentrations during the initial 4 days after injury than patients who had a good outcome.
Language:
eng
MeSH:
Adolescent; Adult; Aged; Biological Markers; Craniocerebral Trauma/blood/classification/*drug therapy; Double-Blind Method; Female; *Glasgow Outcome Scale; Humans; Hypnotics and Sedatives/pharmacology/*therapeutic use; Intracranial Pressure/drug effects; Male; Midazolam/pharmacology/*therapeutic use; Middle Aged; Nerve Growth Factors/*blood; Nitric Oxide/blood/metabolism; Propofol/pharmacology/*therapeutic use; S100 Proteins/*blood
ISSN:
1441-2772 (Print); 1441-2772 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorGhori, Kamran Aen_GB
dc.contributor.authorHarmon, Dominic Cen_GB
dc.contributor.authorElashaal, Abdurrahimen_GB
dc.contributor.authorButler, Marken_GB
dc.contributor.authorWalsh, Fergusen_GB
dc.contributor.authorO'Sullivan, Michael G Jen_GB
dc.contributor.authorShorten, George Den_GB
dc.date.accessioned2012-02-03T15:17:02Z-
dc.date.available2012-02-03T15:17:02Z-
dc.date.issued2012-02-03T15:17:02Z-
dc.identifier.citationCrit Care Resusc. 2007 Jun;9(2):166-71.en_GB
dc.identifier.issn1441-2772 (Print)en_GB
dc.identifier.issn1441-2772 (Linking)en_GB
dc.identifier.pmid17536986en_GB
dc.identifier.urihttp://hdl.handle.net/10147/209279-
dc.description.abstractBACKGROUND: Midazolam and propofol are sedative agents commonly administered to patients with brain injury. We compared plasma concentrations of glial cell S100beta protein and nitric oxide (NO) between patients who received midazolam and those who received propofol sedation after severe brain injury, and investigated the association between S100beta and NO concentrations and neurological outcome. DESIGN: 28 patients with severe head injury (Glasgow Coma Score <9) who required sedation and ventilation were randomly assigned to receive midazolam (n =15) or propofol (n = 13) based sedation. Blood samples were drawn daily for 5 days for estimation of S100beta and NO concentrations. Neurological outcome was assessed 3 months later as good (Glasgow Outcome Score [GOS], 4-5) or poor (GOS, 1-3). RESULTS: A good neurological outcome was observed in 8/15 patients (53%) in the midazolam group and 7/13 patients (54%) in the propofol group. Patients with a poor outcome had higher serum S100beta concentrations on ICU admission and on Days 1-4 in the ICU than those with a good outcome (mean [SD] on Day 1, 0.99 [0.81] v 0.41 [0.4] microg/L; Day 2, 0.80 [0.81] v 0.41 [0.24] microg/L; Day 3, 0.52 [0.55] v 0.24 [0.25] microg/L; and Day 4, 0.54 [0.43] v 0.24 [0.35] microg/L; P<0.05). There was no significant difference on Day 5. Plasma NO concentrations were not associated with outcome. In subgroup analysis, there was no difference in S100beta and NO concentrations between patients with a good outcome versus those with a poor outcome in either the midazolam or propofol group. CONCLUSIONS: Plasma concentrations of markers of neurological injury in patients with severe head injury were similar in those who received midazolam sedation and those who received propofol. Patients who had a poor neurological outcome at 3 months had consistently higher serum S100beta concentrations during the initial 4 days after injury than patients who had a good outcome.en_GB
dc.language.isoengen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshBiological Markersen_GB
dc.subject.meshCraniocerebral Trauma/blood/classification/*drug therapyen_GB
dc.subject.meshDouble-Blind Methoden_GB
dc.subject.meshFemaleen_GB
dc.subject.mesh*Glasgow Outcome Scaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshHypnotics and Sedatives/pharmacology/*therapeutic useen_GB
dc.subject.meshIntracranial Pressure/drug effectsen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMidazolam/pharmacology/*therapeutic useen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshNerve Growth Factors/*blooden_GB
dc.subject.meshNitric Oxide/blood/metabolismen_GB
dc.subject.meshPropofol/pharmacology/*therapeutic useen_GB
dc.subject.meshS100 Proteins/*blooden_GB
dc.titleEffect of midazolam versus propofol sedation on markers of neurological injury and outcome after isolated severe head injury: a pilot study.en_GB
dc.contributor.departmentDepartment of Anaesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Ireland. kamrang@hotmail.comen_GB
dc.identifier.journalCritical care and resuscitation : journal of the Australasian Academy of Critical, Care Medicineen_GB
dc.description.provinceMunster-

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