Propofol Depressed Neutrophil Hydrogen Peroxide Production More Than Midazolam, Whereas Adhesion Molecule Expression was Minimally Affected by both Anesthetics in Rats with Abdominal Sepsis

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Abstract
The treatment of sepsis may require mechanical ventilation of the lungs and sedation. Because neutrophils are the most important effector cells for protecting against sepsis, and propofol and midazolam are the most widely used anesthetics for sedation, we studied the effects of these two anesthetics on the neutrophil function during sepsis. Sepsis was induced in rats by cecal ligation and puncture. At either 4 h or 24 h after cecal ligation and puncture, blood and peritoneal neutrophils were obtained, incubated with the test anesthetics, and the hydrogen peroxide (H2O2) production and CD11b/c expression were determined by flow cytometry. In both early (at 4 h) and late (at 24 h) sepsis, propofol and midazolam depressed H2O2 production by blood and peritoneal neutrophils at clinical concentrations. Propofol caused more depression than midazolam (P < 0.005). In both early and late sepsis, the effect of the anesthetics on the up-regulation of the stimulation-induced CD11b/c expression on blood neutrophils was minimal at clinical concentrations. If these results ultimately become clinically relevant, midazolam may be preferable to propofol for sedation during sepsis. Implications In septic patients, mechanical ventilation of the lungs is sometimes needed, and propofol and midazolam are widely used for sedation. Midazolam was less inhibitory for neutrophil function than propofol during sepsis; thus, midazolam may be preferable to propofol for sedation during sepsis for preserving the neutrophil function to combat sepsis.