The effect of sedative agents on stress hormones and high-sensitive troponin in patients catheterized by permanent-tunnel port catheter

AIM: To evaluate the effect of sedation and analgesia combinations on pain scales, anxiety, adrenocortotropic hormone (ACTH), cortisol, and high-sensitive troponin in patients with a central venous catheter. Materials and Method: This study was prospectively conducted in 90 patients who had been indicated for port catheterization in Hematology and Oncology in the Emergency Medicine Department of Gaziantep University Medical Faculty between 01 March and 01 September 2015. Patients were divided into three groups of 30, as follows: one group received a midazolam-ketamine combination, one group received a midazolam-fentanyl combination, and one group received propofol. Blood pressure, heart rate, and respiratory rate were evaluated. Pain levels were assessed using the Visual Analog Scale, anxiety levels were evaluated using the Beck Anxiety Scale, and blood samples were taken before (0 min) and after the procedure (30 min) in order to obtain ACTH, cortisol and high-sensitive troponin values. These parameters were statistically analyzed and compared, and p<0.05 was accepted as statistically significant in all comparisons. Results: There were no statistically significant differences between the groups with regard to gender and age (p=0.836 and p=0.182). Anxiety significantly decreased in all three groups. A significant decrease in level of pain was found in patients taking midazolam-fentanyl and those who received propofol, and a significant decrease in systolic and diastolic blood pressure was also observed in these two groups. There was no significant respiratory rate increase in any of the three groups. A significant increase in heart rate was observed in patients receiving midazolam-fentanyl and in those receiving midazolam-ketamine. Blood ACTH levels significantly increased in the midazolam-ketamine and propofol groups. In all three groups, no significant cortisol change was found, while significant high-sensitive troponin values were observed. There was no significant difference between the groups. Discussion and Conclusion: Sedative agents can be used efficiently, safely, and simply in minor surgical procedures, such as central venous catheterization. We also recommend the use of analgesics drugs, in addition to anxiolytic and sedative agents, during invasive procedures conducted in the emergency room. KEY WORDS: Port Catheter, Sedation, Anxiety,Troponin