Yonsei Med J.  2011 Mar;52(2):326-332. 10.3349/ymj.2011.52.2.326.

Comparison of the Effects of Propofol and Midazolam on Inflammation and Oxidase Stress in Children with Congenital Heart Disease Undergoing Cardiac Surgery

• Xia WF
• Liu Y
• Zhou QS
• Tang QZ
• Zou HD

• KMID: 1779671
• DOI: http://doi.org/10.3349/ymj.2011.52.2.326

Abstract

PURPOSE
To investigate and compare the effects of propofol and midazolam on inflammation and oxidase stress in children with congenital heart disease undergoing cardiac surgery.
MATERIALS AND METHODS
Thirty-two ASA class I-II children with congenital heart disease undergoing cardiac surgery were randomly divided into two groups: propofol combined with low dose fentanyl (PF group, n = 16) and midazolam combined with low dose fentanyl (MF group, n = 16). Tracheal extubation time and length of Intensive Care Unit (ICU) stay were recorded. Blood samples were taken before operation (T0), at 2 h after release of the aorta cross-clamp (T3) and at 24 h after operation (T4) to measure interleukin 6 (IL-6), IL-8, superoxide dismutase (SOD) and malondialdehyde (MDA) levels. Myocardium samples were collected at 10-20 min after aorta cross-clamp (T1) and at 10-20 min after the release of the aorta cross-clamp (T2) to detect heme oxygenase-1 (HO-1) expression.
RESULTS
Tracheal extubation time and length of ICU stay in PF group were significantly shorter than those of the MF group (p < 0.05, respectively). After cardiopulmonary bypass, IL-6, IL-8 and MDA levels were significantly increased, and the SOD level was significantly reduced in both two groups, but PF group exhibited lower IL-6, IL-8 and MDA levels and higher SOD levels than the MF group (p < 0.05, respectively). The HO-1 expression in the PF group was significantly higher than that in MF group at the corresponding time points (p < 0.05, respectively).
CONCLUSION
Propofol is superior to midazolam in reducing inflammation and oxidase stress and in improving post-operation recovery in children with congenital heart disease undergoing cardiac surgery.

Keyword

Propofol; midazolam; cyanotic heart disease; heme oxygenase-1

MeSH Terms

Anesthesia, Intravenous/*adverse effects
Anesthetics, Intravenous/*adverse effects
Cardiac Surgical Procedures/*adverse effects
Child
Female
Heart Defects, Congenital/*surgery
Heme Oxygenase-1/blood
Humans
Inflammation/*chemically induced
Interleukin-6/blood
Interleukin-8/blood
Male
Malondialdehyde/blood
Midazolam/*adverse effects
Oxidative Stress/*drug effects
Propofol/*adverse effects
Superoxide Dismutase/blood

Figure

• 

  Fig. 1 Comparison of the effects of propofol and midazolam on serum IL-6 and IL-8 levels. Data are shown as mean ± SD. *p < 0.05 vs. T0. †p < 0.05 vs. group MF. IL-6, interleukin 6; PF, propofol combined with low dose fentanyl; MF, midazolam combined with low dose fentanyl.

• 

  Fig. 2 Comparison of the effects of propofol and midazolam on serum SOD and MDA levels. Data are shown as mean ± SD. *p < 0.05 vs. T0. †p < 0.05 vs. group MF. SOD, superoxide dismutase; MDA, malondialdehyde; PF, propofol combined with low dose fentanyl; MF, midazolam combined with low dose fentanyl.

• 

  Fig. 3 Examples of immunohistochemical staining of myocardial HO-1 expression (brown)(Magnification, 400×). (A and C) Myocardial HO-1 expression at T1 and T2 in MF group, respectively. (B and D) Myocardial HO-1 expression at T1 and T2 in PF group, respectively. HO-1, heme oxygenase-1; PF, propofol combined with low dose fentanyl; MF, midazolam combined with low dose fentanyl.

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