title: Dexamethasone decreases the pro- to anti-inflammatory cytokine ratio during cardiac surgery.
abstract: BACKGROUND
  Cytokines regulate inflammation associated with cardiopulmonary bypass (CPB). Pro-inflammatory cytokines may cause myocardial dysfunction and haemodynamic instability after CPB, but the release of anti-inflammatory cytokines is potentially protective. We studied the effects of dexamethasone on pro- and anti-inflammatory cytokine responses during coronary artery bypass grafting surgery.
  
  
  METHODS
  Seventeen patients were studied: nine patients received dexamethasone 100 mg before induction of anaesthesia (group 1) and eight patients acted as controls (group 2). Plasma levels of tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8, IL-10 and IL-4 were measured perioperatively.
  
  
  RESULTS
  TNF-alpha and IL-8 did not increase significantly in group 1 whereas they increased in group 2 to greater than preoperative values (P<0.05). IL-6 increased in both groups, with lower values in group 1 than in group 2 (P<0.05). IL-10 increased in both groups, with higher values in group 1 (P<0.05). IL-4 did not change in group 1 but decreased in group 2 compared with pre-induction values (P<0.05). After surgery, patients in group 2 had tachycardia, hyperthermia, a greater respiratory rate and higher pulmonary artery pressure, and a longer stay in the intensive care unit.
  
  
  CONCLUSIONS
  Dexamethasone given before cardiac surgery changes circulating cytokines in an anti-inflammatory direction. Postoperative outcome may be improved by inhibition of the systemic inflammatory response.
authors.affiliation: Department of Anaesthesia and Intensive Care, Amphia Hospital, Breda, The Netherlands.
authors.forename: S R
authors.initials: SR
authors.lastname: El Azab
authors.forename: P M J
authors.initials: PM
authors.lastname: Rosseel
authors.forename: J J
authors.initials: JJ
authors.lastname: de Lange
authors.forename: A B J
authors.initials: AB
authors.lastname: Groeneveld
authors.forename: R
authors.initials: R
authors.lastname: van Strik
authors.forename: E M
authors.initials: EM
authors.lastname: van Wijk
authors.forename: G J
authors.initials: GJ
authors.lastname: Scheffer
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016207:Cytokines / Q000097:blood / Q000187:drug effects*; D003907:Dexamethasone / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D016753:Interleukin-10 / Q000097:blood; D015847:Interleukin-4 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D000893:Anti-Inflammatory Agents; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D015847:Interleukin-4; D003907:Dexamethasone