Effectiveness of the combination of midazolam and dexmedetomidine on the perioperative stress response evaluated by IL-6, HSP60, and cortisol levels

Abstract

Background & objective: Stress response to surgery is a reaction to tissue damage with wide-ranging effects in the neuroendocrine and immunological fields. The synergistic effects of midazolam and dexmedetomidine can inhibit this response. We aimed to determine the inhibiting effect of the combination of midazolam and dexmedetomidine on the perioperative stress response compared to midazolam alone. Methodology: A total of 40 patients scheduled to undergo total knee or hip replacement surgery with regional anesthesia were included in this double-blind, randomized controlled trial with a pre-test and post-test design. The participants were divided into two study groups: the treatment group (Group MD) and the control group (Group M). Changes in body stress response during surgery were assessed by measuring Interleukin 6 (IL-6), HSP60, and cortisol levels in the blood samples using ELISA. Results: The test results of the subject showed significant differences in the IL-6 (P = 0.043), HSP60 (P = 0.001), and cortisol levels (P = 0.016). Multivariate analysis using Hotelling’s T square test showed P < 0.01. Furthermore, discriminant analysis showed that combining midazolam and dexmedetomidine significantly reduced HSP60 and cortisol levels. Conclusion: The combination of midazolam and dexmedetomidine proved more effective than midazolam alone in reducing the perioperative stress response in patients scheduled to undergo total knee or hip replacement surgery under regional anesthesia. Abbreviations: IL-6 - Interleukin-6; LoS - Length of stay; Keywords: Surgical stress response; Arthroplasty; Midazolam; Dexmedetomidine Citation: Sembada RH, Suromo LB, Harahap MS, Susanto H, Budijitno S, Erwinanto. Effectiveness of the combination of midazolam and dexmedetomidine on the perioperative stress response evaluated by IL-6, HSP60, and cortisol levels. Anaesth. pain intensive care 2024;28(3):408−415; DOI: 10.35975/apic.v28i3.2461 Received: January 10, 2024; Revised: April 09, 2024; Accepted: April 09, 2024