title: Peroperative cardiovascular stability during brainstem surgery. The use of high-dose methylprednisolone compared to dexamethasone. A retrospective analysis.
abstract: BACKGROUND
  In neurosurgical procedures within brainstem structures, corticosteroids are routinely administered to prevent oedema and to reduce intraoperative trauma. After replacing the routine administration of dexamethasone (DX) by high-dose methylprednisolone (MP) during surgery for tumours within brainstem structures, a decreased incidence of intraoperative haemodynamic instability events was observed. To test this hypothesis, a retrospective analysis was performed.
  
  
  METHODS
  Peroperative data of 62 surgical procedures of brainstem tumours were retrospectively analysed with respect to haemodynamic instability requiring changes in surgical strategy and/or emergence medication with vasoactive drugs. Severe changes in haemodynamic parameters were defined as a significant increase or decrease in heart rate and/or mean arterial blood pressure greater than 30% compared to baseline values. From 1988 to 1994, intravenous dexamethasone was given peroperatively in 33 patients. After a bolus of 1 mg kg(-1) body weight (BW) 30 min preoperatively, 0.2 mg kg(-1) were given every 4 h. From 1994 until now, methylprednisolone was administered instead of dexamethasone in 29 patients. After an initial bolus of 30 mg kg(-1) BW immediately before surgery, 5.4 mg kg(-1) h(-1) were given 23 h postoperatively.
  
  
  RESULTS
  The results of this retrospective analysis suggest that the number of operations with episodes of bradycardia, arterial hypotension (P<0.05), tachycardia and arterial hypertension (P<0.005) was significantly decreased in the group of patients treated with high-dose methylprednisolone.
  
  
  CONCLUSIONS
  The retrospective analysis of the clinical data showed that the routine use of high-dose methylprednisolone was associated with a decreased incidence of haemodynamic instability in a selected group of patients undergoing brainstem surgery. This finding has to be proven in prospective double-blind controlled studies.
authors.affiliation: Klinik und Poliklinik für Neurochirurgie, Georg-August-University, Göttingen, Germany. juliaetkay@aol.com
authors.forename: K
authors.initials: K
authors.lastname: Mursch
authors.forename: W
authors.initials: W
authors.lastname: Buhre
authors.forename: J
authors.initials: J
authors.lastname: Behnke-Mursch
authors.forename: E
authors.initials: E
authors.lastname: Markakis
mesh_terms: D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control; D001929:Brain Edema / Q000209:etiology / Q000517:prevention & control; D001933:Brain Stem / Q000601:surgery*; D020295:Brain Stem Neoplasms / Q000601:surgery; D002648:Child; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D018696:Neuroprotective Agents / Q000008:administration & dosage*; D011300:Preoperative Care; D012189:Retrospective Studies
chemical_list: D005938:Glucocorticoids; D018696:Neuroprotective Agents; D003907:Dexamethasone; D008775:Methylprednisolone