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We aimed to select the sedative drug with the least impact on hepatic blood flow in sedation-administered patients. In our study, we aimed to establish whether or not midazolam and propofol affect liver function during sepsis. The hepatic blood flow is evaluated by the transcutaneous assessment of the indocyanine green plasma disappearance rate (ICG-PDR) in critically ill patients.
Forty sepsis patients were included in the study with either the loading dose infusion of propofol 1 mg/kg over 15 minutes followed by a maintenance 1 to 3 mg/kg/hour (n = 20, Group P) or a loading dose of midazolam 0.2 mg/kg over 10 minutes followed by a maintenance 0.04 to 0.06 mg/kg/hour (n = 20, Group M), 24 hours infusion. ICG elimination tests were conducted concurrently using the non-invasive liver function monitoring system (LiMON). A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus and immediately flushed with 10 ml normal saline. We calculated ICG-PDR. The ICG-PDR measurements were obtained at baseline (before start of the propofol or midazolam infusion) and were repeated at 24 hours. Biochemical and hemodynamic parameters, ICG-PDR were recorded before start of the study and at 24 hours.
Biochemical and hemodynamic parameters did not differ significantly between the groups (P < 0.05). Group P compared with Group M; baseline ICG-PDR levels (23.67 ± 12.02 vs 23.86 ± 11.4, respectively), and after the study ICG-PDR levels (26.04 ± 13.60 vs 24.07 ± 9.07) did not differ in groups (P > 0.05). When we examined before and after ICG-PRD changes between groups, there was no significant difference (P > 0.05).
In our study, we found that neither propofol nor midazolam infusion affected hepatic blood flow.