Comparing the effect of preoperative administration of methylprednisolone and its administration before and during surgery on the clinical outcome in pediatric open heart surgeries

Ghasem Soltani, Mohammad Abbasi Tashnizi, Ali Asghar Moeinipour, Mahmoud Ganjifard, Jamil Esfahanizadeh, Alireza Sepehri Shamloo, Seyed Javad Purafzali Firuzabadi, Nahid Zirak, Ghasem Soltani, Mohammad Abbasi Tashnizi, Ali Asghar Moeinipour, Mahmoud Ganjifard, Jamil Esfahanizadeh, Alireza Sepehri Shamloo, Seyed Javad Purafzali Firuzabadi, Nahid Zirak

Abstract

Background: Cardiac surgery under Cardiopulmonary bypass causes a systemic inflammatory response with a multifactorial etiology including direct tissue damage, ischemia and stimulation of immune system induced by cardiopulmonary bypass. This study was designed due to the high prevalence and complications of this stimulated immune system in mortality, morbidity, length of ICU stay, and mechanical ventilation.

Objectives: This study was aimed to compare preoperative and intraoperative methylprednisolone (MP) to intraoperative MP alone with respect to postbypass inflammation and clinical outcome.

Patients and methods: Sixty pediatric patients (age < 5years) undergoing cardiopulmonary bypass surgery between September 2011-2012 at Imam Reza hospital-Mashhad were randomly assigned to receive preoperative and intraoperative MP (group 1: 30 mg/kg, 4 hours before bypass and in bypass prime, n = 30) or intraoperative MP only (group 2: 30 mg/kg, n = 30). Postoperative temperature (peak temperature and average temperature during the first 24 hours), amount of inotropic, duration of mechanical ventilation, ICU stay, WBC, BUN, creatinine, and CRP were recorded and compared in both groups. Data were analyzed with SPSS version 13 by T-test, Mann-Whitney test if necessary, and Chi-squared distribution.

Results: Patient characteristics including age, weight, gender, and duration of bypass were almost similar in both groups (P > 0.05). No significant difference in amount of inotropic medications used for hemodynamic supports, duration of mechanical ventilation, peak and average temperature and length of ICU stay was observed. Among the laboratory tests (WBC, BUN, creatinine, CRP) only WBC counts raised more in group 2 when compared to group 1(P < 0.05).

Conclusions: There was no difference in clinical outcome after cardiac surgery when we administered an additional dose of methylprednisolone compared to a single dose of methylprednisolone.

Keywords: Cardiopulmonary Bypass; Congenital; Heart Defects; Inflammation.

References

    1. Schroeder VA, Pearl JM, Schwartz SM, Shanley TP, Manning PB, Nelson DP. Combined steroid treatment for congenital heart surgery improves oxygen delivery and reduces postbypass inflammatory mediator expression. Circulation. 2003;107(22):2823–8. doi: 10.1161/01.CIR.0000070955.55636.25.
    1. Bourbon A, Vionnet M, Leprince P, Vaissier E, Copeland J, McDonagh P, et al. The effect of methylprednisolone treatment on the cardiopulmonary bypass-induced systemic inflammatory response. Eur J Cardiothorac Surg. 2004;26(5):932–8. doi: 10.1016/j.ejcts.2004.07.044.
    1. Hoffman TM, Wernovsky G, Atz AM, Kulik TJ, Nelson DP, Chang AC, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation. 2003;107(7):996–1002.
    1. Deng MC, Dasch B, Erren M, Mollhoff T, Scheld HH. Impact of left ventricular dysfunction on cytokines, hemodynamics, and outcome in bypass grafting. Ann Thorac Surg. 1996;62(1):184–90.
    1. Ng CS, Wan S. Limiting inflammatory response to cardiopulmonary bypass: pharmaceutical strategies. Curr Opin Pharmacol. 2012;12(2):155–9. doi: 10.1016/j.coph.2012.01.007.
    1. Chaney MA. Corticosteroids and cardiopulmonary bypass : a review of clinical investigations. Chest. 2002;121(3):921–31.
    1. Chaney MA, Durazo-Arvizu RA, Nikolov MP, Blakeman BP, Bakhos M. Methylprednisolone does not benefit patients undergoing coronary artery bypass grafting and early tracheal extubation. J Thorac Cardiovasc Surg. 2001;121(3):561–9. doi: 10.1067/mtc.2001.112343.
    1. Tassani P, Richter JA, Barankay A, Braun SL, Haehnel C, Spaeth P, et al. Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures? J Cardiothorac Vasc Anesth. 1999;13(2):165–72.
    1. Haynes R, Murad F. Adrenocorticotrophic hormone, adrenocortical steroids and their synthetic analogs: inhibitors of adrenocortical steroid biosynthesis. In: Gilman A, Goodman L, Rall T, editors. The Pharmacological Basis of Therapeutics. 7 ed. New York: Macmillan Publishing Co.; 1985. pp. 1459–89.
    1. Ito S, Kusunoki Y, Oka T, Ito Y, Okuno A, Yoshioka H. Pharmacokinetics of high-dose methylprednisolone in children. Dev Pharmacol Ther. 1992;19(2-3):99–105.
    1. Kong AN, Jungbluth GL, Pasko MT, Beam TR, Jusko WJ. Pharmacokinetics of methylprednisolone sodium succinate and methylprednisolone in patients undergoing cardiopulmonary bypass. Pharmacotherapy. 1990;10(1):29–34.
    1. Graham EM, Atz AM, Butts RJ, Baker NL, Zyblewski SC, Deardorff RL, et al. Standardized preoperative corticosteroid treatment in neonates undergoing cardiac surgery: results from a randomized trial. J Thorac Cardiovasc Surg. 2011;142(6):1523–9. doi: 10.1016/j.jtcvs.2011.04.019.
    1. Bronicki RA, Backer CL, Baden HP, Mavroudis C, Crawford SE, Green TP. Dexamethasone reduces the inflammatory response to cardiopulmonary bypass in children. Ann Thorac Surg. 2000;69(5):1490–5.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться