Preoperative high dose methylprednisolone improves patients outcome after abdominal surgery.
OBJECTIVE
To assess the effect of preoperative high dose methylprednisolone on stress response and outcome.


METHODS
Randomised, placebo-controlled, double-blind study.


METHODS
University hospital, Germany.


METHODS
20 patients listed for abdominal surgery of whom 10 had major intra-abdominal interventions and 10 had incisional hernias repaired.


METHODS
Methylprednisolone 30 mg/kg (100 ml) was given by slow intravenous infusion 90-60 minutes before operation. The control group received the same volume of sodium chloride.


METHODS
Speed of convalescence, degree of fatigue, amount of pain, consumption of analgesics, breathing capacity, and hospital stay, as well as humoral and cellular mediators of the stress response.


RESULTS
Methylprednisolone significantly improved criteria of postoperative recovery, fatigue by 47%, (day 1), convalescence by about 45% (days 1-3), and breathing capacity (FEV1) between 47% and 29% (days 5, 7) (p < 0.05, ANOVA), and led to a significant reduction of median hospital stay of 4.5 days. C-reactive protein concentration was significantly decreased (by 46% on day 3) and T-cell activation was suppressed (day 1).


CONCLUSIONS
Outcome of the patients after conventional abdominal surgery is substantially improved by preoperative high dose methylprednisolone. This effect is more pronounced in patients having major operations.
Nagelschmidt
M
M
Biochemical and Experimental Division, University of Cologne, Germany.
Fu
Z X
ZX
Saad
S
S
Dimmeler
S
S
Neugebauer
E
E
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002097:C-Reactive Protein / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006555:Hernia, Ventral / Q000601:surgery; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D011292:Premedication; D013312:Stress, Physiological / Q000175:diagnosis / Q000517:prevention & control*; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000517:prevention & control*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D018836:Inflammation Mediators; D002097:C-Reactive Protein; D008775:Methylprednisolone