Dexamethasone reduces postoperative troponin levels in children undergoing cardiopulmonary bypass.
OBJECTIVE
We previously demonstrated that dexamethasone treatment before cardiopulmonary bypass in children reduces the postoperative systemic inflammatory response. The purpose of this study was to test the hypothesis that dexamethasone administration before cardiopulmonary bypass in children correlates with a lesser degree of myocardial injury as measured by a decrease in cardiac troponin I release.


METHODS
A prospective, randomized, double-blind study.


METHODS
The cardiac surgery operating room and intensive care unit of a pediatric referral hospital.


METHODS
Twenty-eight patients who underwent open-heart surgery for congenital heart defects.


METHODS
Patients received either placebo (group I, n = 13) or dexamethasone, 1 mg/kg iv (group II, n = 15), 1 hr before initiation of cardiopulmonary bypass. Plasma cardiac troponin I samples were obtained at three time points: immediately before study agent (sample 1), 10 mins after protamine sulfate administration after cardiopulmonary bypass (sample 2), and 24 hrs postoperatively (sample 3).


RESULTS
Mean cardiac troponin I levels (+/-sd) were significantly lower at sample time 3 in group II (dexamethasone; 33.4 +/- 20.0 ng/mL) vs. group I (control; 86.9 +/- 81.1) (p =.04).


CONCLUSIONS
Dexamethasone administration before cardiopulmonary bypass in children resulted in a significant decrease in cardiac troponin I levels at 24 hrs postoperatively. We postulate that this may represent a decrease in myocardial injury, and, thus, a possible cardioprotective effect produced by dexamethasone.
Checchia
Paul A
PA
Department of Surgery, Division of Pediatric Critical Care Medicine, Northwestern University Medical School, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614, USA.
Backer
Carl L
CL
Bronicki
Ronald A
RA
Baden
Harris P
HP
Crawford
Susan E
SE
Green
Thomas P
TP
Mavroudis
Constantine
C
D000704:Analysis of Variance; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D009202:Cardiomyopathies / Q000097:blood / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D019210:Troponin I / Q000097:blood*
D000893:Anti-Inflammatory Agents; D019210:Troponin I; D003907:Dexamethasone