Preoperative administration of steroids: influence on adhesion molecules and cytokines after cardiopulmonary bypass.
Ann Thorac Surg
; 72(4): 1316-20, 2001 Oct.
Article
in En
| MEDLINE
| ID: mdl-11603453
ABSTRACT
BACKGROUND:
Cardiopulmonary bypass (CPB) is associated with tissue damage mediated by adhesion molecules and cytokines. Prebypass steroid administration may modulate the inflammatory response, resulting in improved postoperative recovery.METHODS:
Fifty patients undergoing elective coronary operations under normothermic CPB were randomized into two groups group A (n = 24) received intravenous methylprednisolone (10 mg/kg) 4 hours preoperatively, and group B (n = 26) served as controls. Cytokines (tumor necrosis factor-alpha [TNF-alpha], interleukin-2R [IL-2R], IL-6, IL-8), soluble adhesion molecules (sE-selectin, sICAM-1), C-reactive protein, and leukocytes were measured before steroid application, then 24 and 48 hours, and 6 days postoperatively. Adhesion molecules were measured by enzyme-linked immunosorbent assay, cytokines by chemiluminescent immunoassay. Postoperatively, hemodynamic measurements, inotropic agent requirements, blood loss, duration of mechanical ventilation, and intensive care unit stay were compared.RESULTS:
Aortic cross-clamp and CPB time was similar in both groups. Prednisolone administration reduced postoperative levels of IL-6 (611 versus 92.7 pg/mL; p = 0.003), TNF-alpha (24.4 versus 11.0 pg/L, p = 0.02), and E-selectin (327 versus 107 ng/mL, p = 0.02). Postoperative recovery did not differ between groups.CONCLUSIONS:
Preoperative administration of methylprednisolone blunted the increase of IL-6, TNF-alpha, and E-selectin levels after CPB but had no measurable effect on postoperative recovery.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Postoperative Complications
/
Premedication
/
Cardiopulmonary Bypass
/
Cell Adhesion Molecules
/
Coronary Artery Bypass
/
Cytokines
/
Methylprednisolone Hemisuccinate
/
Systemic Inflammatory Response Syndrome
Type of study:
Clinical_trials
/
Observational_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Ann Thorac Surg
Year:
2001
Document type:
Article
Affiliation country:
Suiza