Preoperative administration of steroids: influence on adhesion molecules and cytokines after cardiopulmonary bypass.
BACKGROUND
Cardiopulmonary bypass (CPB) is associated with tissue damage mediated by adhesion molecules and cytokines. Prebypass steroid administration may modulate the inflammatory response, resulting in improved postoperative recovery.


METHODS
Fifty patients undergoing elective coronary operations under normothermic CPB were randomized into two groups: group A (n = 24) received intravenous methylprednisolone (10 mg/kg) 4 hours preoperatively, and group B (n = 26) served as controls. Cytokines (tumor necrosis factor-alpha [TNF-alpha], interleukin-2R [IL-2R], IL-6, IL-8), soluble adhesion molecules (sE-selectin, sICAM-1), C-reactive protein, and leukocytes were measured before steroid application, then 24 and 48 hours, and 6 days postoperatively. Adhesion molecules were measured by enzyme-linked immunosorbent assay, cytokines by chemiluminescent immunoassay. Postoperatively, hemodynamic measurements, inotropic agent requirements, blood loss, duration of mechanical ventilation, and intensive care unit stay were compared.


RESULTS
Aortic cross-clamp and CPB time was similar in both groups. Prednisolone administration reduced postoperative levels of IL-6 (611 versus 92.7 pg/mL; p = 0.003), TNF-alpha (24.4 versus 11.0 pg/L, p = 0.02), and E-selectin (327 versus 107 ng/mL, p = 0.02). Postoperative recovery did not differ between groups.


CONCLUSIONS
Preoperative administration of methylprednisolone blunted the increase of IL-6, TNF-alpha, and E-selectin levels after CPB but had no measurable effect on postoperative recovery.
Schurr
U P
UP
Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
Zünd
G
G
Hoerstrup
S P
SP
Grünenfelder
J
J
Maly
F E
FE
Vogt
P R
PR
Turina
M I
MI
D000368:Aged; D002315:Cardiopulmonary Bypass; D015815:Cell Adhesion Molecules / Q000097:blood*; D001026:Coronary Artery Bypass; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage*; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011292:Premedication; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis*
D015815:Cell Adhesion Molecules; D016207:Cytokines; D008776:Methylprednisolone Hemisuccinate