Abstract

*Tomoki Nishiyama MD, PhD

ABSTRACT

Background: Cytokines produced in the brain cause worse outcome following traumatic brain injury. Effects of midazolam on cytokine in trauma or ischemic disease have been studied. We could expect midazolam could inhibit production of cytokines in the brain. This study investigated the effects of midazolam on cytokine production in the brain during brain tumor resection. Methods: Twelve patients for brain tumor resection using spinal drainage were divided into the Midazolam and Control groups. Anesthesia was maintained with isoflurane and nitrous oxide in oxygen. In the Midazolam group, midazolam was infused with 0.68 mg/kg/h for the first 15 min. followed by 0.25 mg/kg/h. IL-6, IL-8, and TNF? in the arterial blood, internal jugular vein and cerebrospinal fluid (CSF) were measured before surgery, after craniotomy, 2 hours in brain manipulation, and end of surgery. Results: IL-6 significantly increased in artery and jugular vein in both groups, but no significant differences were found between the groups. IL-6 in the CSF increased significantly at the end of surgery in both groups with significantly higher values in the Control group. In the CSF, IL-8 significantly increased in both groups with significantly higher values in the Control group at the end of surgery. TNF? significantly increased in artery, jugular vein and CSF with significantly higher values in the Control group after craniotomy. Conclusions: Continuous infusion of midazolam during brain tumor resection decreased production of IL-6 and IL-8 in the brain and TNF? in the brain and systemic circulation.