Critical Care and Shock

Effect of sedation after abdominal surgery in modulating stress response: The impact of dexmedetomidine and midazolam on cortisol level, interleukin 6 (IL-6) level, and blood glucose level

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Objective: This study compared the effects of dexmedetomidine and midazolam on stress response markers such as interleukin 6 (IL-6) level, cortisol level, and blood glucose level in patients who needed postoperative mechanical ventilation support after abdominal surgery.

Design: Single-center, double-blinded, randomized clinical trial.

Setting: This study was conducted from November 2018 to March 2019 at the Intensive Care Unit (ICU) of Dr. Cipto Mangunkusumo National Central Public Hospital.

Patients and participants: Twenty-two adult patients who underwent abdominal surgeries and received sedation agents in the ICU were divided into Group D (dexmedetomidine) and Group M (midazolam). Inclusion criteria included patients aged 18-65, American Society of Anaesthesiologists (ASA) physical status classification I-III, and indicated the use of mechanical ventilation after abdominal surgery.

Interventions: Each agent was administered after the patient arrived at the ICU without a loading dose.

Measurements and results: Dexmedetomidine and midazolam were unable to lower stress responses due to only significance in one out of three decided parameters statistically. A decrease in blood glucose level occurred in Group M six hours after abdominal surgery (blood glucose before any sedation agent was administered [T0] p=0.470, blood glucose measured 120 minutes after sedation [T1] p=0.870, blood glucose measured 360 minutes after sedation [T2] p=0.028, blood glucose level changes p=0.008), while there were no significant changes in IL-6 level (IL-6 T0 p=0.844, IL-6 T1 p=0.818, IL-6 T2 p=0.768, IL-6 level changes p=0.974) and cortisol level (cortisol T0 p=0.017, cortisol T1 p=0.974, cortisol T2 p=0.577, cortisol level changes p=0.279). Agitation in Group D showed significant differences compared to Group M (p=0.027), while there was no significant difference in anxiety within both groups (p=1.000).

Conclusions: As sedation agents, both dexmedetomidine and midazolam were unable to lower stress responses in a patient with mechanical ventilation after abdominal surgery. The sedation level in Group D showed better results compared to Group M, but both agents could reduce the anxiety level.