Effects of propofol and dexmedetomidine on indocyanine green elimination assessed with LIMON to patients with early septic shock: a pilot study.

摘要

BACKGROUND: 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 dexmedetomidine and propofol affect liver function during early septic shock. The hepatic blood flow is evaluated by the transcutaneous assessment of indocyanine green plasma disappearance rate (ICG-PDR) in critically ill patients. METHODS: Forty early septic shock patients were included in the study and administered either the loading dose infusion of propofol (n = 20, group P) of 1 mg/kg over 15 minutes followed by a maintenance dose of 1 to 3 mg/kg per hour (n = 20, group P), or a loading dose of dexmedetomidine 1 microg/kg over 10 minutes followed by a maintenance of 0.2 to 2.5 microgg/kg per hour (n = 20, group D) (24-hour infusion). Indocyanine green (ICG) elimination tests were conducted concurrently using the noninvasive liver function monitoring system (LiMON; Pulsion Medical Systems, Munich, Germany). A dose of 0.3 mg/kg of ICG was given through a cubital fossa vein as a bolus and immediately flushed with 10 mL of normal saline. We calculated ICG-PDR. Indocyanine green plasma disappearance rate measurements were obtained at baseline (before start of the propofol or dexmedetomidine infusion) and were repeated at the 24th hour. Biochemical and hemodynamic parameters and ICG-PDR were recorded before start of the study and at 24th hour. RESULTS: Biochemical and hemodynamic parameters did not differ significantly between the groups (P < .05). Baseline ICG-PDR levels of group P compared to group D were 24.7 +/- 14.4 vs 22.2 +/- 10.7, respectively, and after the study, ICG-PDR levels (26.5 +/- 13.7 vs 23.7 +/- 12.4) did not differ in groups (P > .05). When we examined ICG-PDR changes between groups before and after administration, there was no significant difference (P > .05). CONCLUSION: In our study, we found that neither propofol nor dexmedetomidine infusion affected hepatic blood flow.