Peroperative cardiovascular stability during brainstem surgery. The use of high-dose methylprednisolone compared to dexamethasone. A retrospective analysis.
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.
Mursch
K
K
Klinik und Poliklinik für Neurochirurgie, Georg-August-University, Göttingen, Germany. juliaetkay@aol.com
Buhre
W
W
Behnke-Mursch
J
J
Markakis
E
E
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
D005938:Glucocorticoids; D018696:Neuroprotective Agents; D003907:Dexamethasone; D008775:Methylprednisolone