Publication

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

Ghori, Kamran A
; 
Harmon, Dominic C
; 
Elashaal, Abdurrahim
; 
Butler, Mark
; 
Walsh, Fergus
; 
O'Sullivan, Michael G J
; 
Shorten, George D
Authors
Ghori, Kamran A
 Harmon, Dominic C
 Elashaal, Abdurrahim
 Butler, Mark
 Walsh, Fergus
 O'Sullivan, Michael G J
 Shorten, George D
Advisors
Editors
Other Contributors
Departments
Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Ireland. kamrang@hotmail.com
Date
2012-02-03T15:17:02Z
Date Submitted
Keywords
Other Subjects
Subject 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
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
URI
http://hdl.handle.net/10147/209279
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
Citation
Crit Care Resusc. 2007 Jun;9(2):166-71.
ISSN
1441-2772 (Print)
1441-2772 (Linking)
eISSN
ISBN
DOI
PMID
17536986
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