title: Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures?
abstract: OBJECTIVE
  To discover the possible effects of methylprednisolone on the systemic inflammatory response during aprotinin treatment.
  
  
  METHODS
  Randomized, double-blinded study.
  
  
  METHODS
  University-affiliated heart center.
  
  
  METHODS
  Fifty-two patients scheduled for elective coronary artery bypass grafting.
  
  
  METHODS
  In the methylprednisolone group (n = 26), 1 g of methylprednisolone was administered 30 minutes before cardiopulmonary bypass (CPB). The 26 control patients received a placebo instead. High-dose aprotinin was administered to all participants.
  
  
  RESULTS
  After CPB, the concentration of the proinflammatory cytokines, interleukin-6 and interleukin-8, was significantly less in the methylprednisolone group. The anti-inflammatory interleukin-10 concentration was, in contrast, greater. After CPB, PaO2 was greater in the methylprednisolone group (245+/-17 v 195+/-16 mmHg). Dynamic pulmonary compliance was also greater, whereas the alveolar-arterial oxygen difference was less (376+/-17 v 428+/-16 mmHg). On arrival in the intensive care unit, the oxygen delivery index was greater in the methylprednisolone group (62+/-2.7 v 54+/-2.3 mL/min/m2) and the oxygen extraction rate was less (25%+/-0.02% v 30%+/-0.02%). After CPB, the cardiac index was significantly greater in the methylprednisolone group (4.1+/-0.2 v 3.6+/-0.2 L/min/m2). These patients had less blood loss postoperatively (616+/-52 v 833+/-71 mL; p = 0.017) and a greater urine output (8,015+/-542 v 6,417+/-423 mL/24 h; p = 0.024).
  
  
  CONCLUSIONS
  The use of methylprednisolone attenuates the systemic inflammatory response during aprotinin treatment and improves clinical outcome parameters.
authors.affiliation: Institute of Anesthesiology, Department of Cardiac Surgery, German Heart Center Munich at the Technical University, München.
authors.forename: P
authors.initials: P
authors.lastname: Tassani
authors.forename: J A
authors.initials: JA
authors.lastname: Richter
authors.forename: A
authors.initials: A
authors.lastname: Barankay
authors.forename: S L
authors.initials: SL
authors.lastname: Braun
authors.forename: C
authors.initials: C
authors.lastname: Haehnel
authors.forename: P
authors.initials: P
authors.lastname: Spaeth
authors.forename: H
authors.initials: H
authors.lastname: Schad
authors.forename: H
authors.initials: H
authors.lastname: Meisner
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007611:Aprotinin / Q000008:administration & dosage / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D002302:Cardiac Output / Q000187:drug effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis; D016753:Interleukin-10 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D008170:Lung Compliance / Q000187:drug effects; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000187:drug effects; D010919:Placebos; D011292:Premedication; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control*; D016896:Treatment Outcome; D014556:Urine
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D006490:Hemostatics; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D010919:Placebos; D016753:Interleukin-10; D007611:Aprotinin; D010100:Oxygen; D008775:Methylprednisolone