Effects of dexamethasone on clinical course, C-reactive protein, S100B protein and von Willebrand factor antigen after paediatric cardiac surgery.
BACKGROUND
Anti-inflammatory treatment with glucocorticoids during cardiopulmonary bypass can reduce inflammatory mediator release, but the effects of glucocorticoid on outcome are controversial.


METHODS
We studied the effects of dexamethasone on clinical course, C-reactive protein, von Willebrand factor antigen (vWf:Ag) and S100B in a randomized masked study of children after open cardiac surgery. Twenty children weighing >10 kg received dexamethasone (1 mg kg(-1)) and 20 controls received saline after induction of anaesthesia. We measured vWf:Ag as a marker of endothelial activation, S100B as a marker of cerebral protein release and C-reactive protein as a marker of inflammatory activity. Oxygenation, body temperature, fluid balance, leucocyte and platelet counts, days in the intensive care unit (ICU) and days on mechanical ventilation were noted.


RESULTS
Dexamethasone decreased C-reactive protein concentration on the first postoperative day (P<0.05), but did not affect the release of vWf:Ag or S100B. There was no significant difference in oxygenation, body temperature, fluid balance, leucocyte and platelet counts, days in the ICU or days on mechanical ventilation between the placebo and dexamethasone-treated groups.


CONCLUSIONS
Administration of dexamethasone before cardiopulmonary bypass for paediatric cardiac surgery decreased the inflammatory response, but did not affect the immediate features after surgery or changes in vWf:Ag or S100B.
Lindberg
L
L
Department of Pediatric Anesthesia and Intensive Care, University Hospital, Lund, Sweden. larsolavlindberg@hotmail.com
Forsell
C
C
Jögi
P
P
Olsson
A-K
AK
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000517:prevention & control*; D018836:Inflammation Mediators / Q000097:blood*; D009414:Nerve Growth Factors / Q000097:blood; D011183:Postoperative Complications / Q000517:prevention & control; D011229:Preanesthetic Medication; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood; D014841:von Willebrand Factor / Q000378:metabolism
D000893:Anti-Inflammatory Agents; D018836:Inflammation Mediators; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human; D014841:von Willebrand Factor; D003907:Dexamethasone; D002097:C-Reactive Protein