الفهرس 
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Abstract
Preeclampsia (PE), a pregnancy-specific disease characterized by hypertension and proteinuria diagnosed after 20 weeks of gestation. It is a leading cause of maternal and neonatal morbidity and mortality. The pathogenesis of PE is unclear, however, a lot of studies have been suggested that hypoxic placenta is the principal contributor to the pathogenesis of preeclampsia. The hypoxic placenta is a potential source of varied factors that initiate endothelial dysfunction responsible for clinical signs and symptoms of PE. Among these factors is inflammatory response. Inflammatory response is marked by increased concentration of cytokines (IL-6 & IL-1) and acute phase reaction protein (CRP). Although, the only cure of PE is a delivery of baby and placenta, the preeclamptic patients admitted to ICU require postoperative sedation and analgesia. Midazolam is a traditional sedative in ICU many decades ago for a wide range of condition. Dexmedetomidine is a newly established sedative-analgesic in ICU acting by different mechanism from traditional agents. The aim of the current study is to Compare between dexmedetomidine and midazolam as a curative agents in preeclamptic patients via study of their effect on hemodynamic status and inflammatory response. This study was performed on 50 preeclamptic patients at Mansoura University Hospital. The patients was randomly allocated into 2 equal groups (25 patients each): Group-M: received midazolam immediately after delivery in a loading dose of 10mg in 100 ml 0.9% Nacl at 0.05 mg/kg, followed by continuous infusion at 0.1 mg/kg/hour. Group-D: received dexmedetomidine immediately after delivery in a loading dose of 1ug/kg per 20 minute followed by continuous infusion at 0.7 ug/hour. Immediately before delivery, the patients were evaluated by measurement of blood pressure, heart rate, CVP, O2 saturation, sedation score. Blood sample was taken for CBC, measurement of concentration of concentration of IL-6, CRP & cortisol. Baseline values were recorded. Subarachinoid block was done for caessarian section. Intraoperative standard monitoring was done. Postoperatively, patients were admitted to ICU where immediately after delivery measurements of the same previously mentioned parameters were done. Then under drug infusion, measurements of blood pressure, heart rate, CVP, O2 saturation, sedation level, analgesic levels, concentration of IL-6, CRP and cortisol were measured every 2 hours. The results of this study reveled that :- •The level of sedative was increased in both groups with higher levels in group-D compared to group-M. •The VAS was decreased in both groups with more decrease in group-D compared to group-M. •MAP and heart rate was reduced in group-D more than in group-M with significant reduction in requirement to nitroglycerine and period of ICU stay.•No significant difference for CVP or O2 saturation at any given time of measurement in both groups. •IL-6 & CRP was significantly reduced in group-D than group-M. In conclusion, the result of this study have shown that DEX is a sedative and analgesic with hemodynamic effect that reduce the antihypertensive requirement and decrease the period of ICU stay. In addition, it has an anti-inflammatory effect which is an important factor in improvement of the patient’s outcome.