Dexamethasone reduces gut permeability in pediatric cardiac surgery.
OBJECTIVE
Little attention has been paid to the effect of the systemic inflammatory response syndrome on intestinal dysfunction in the postoperative period. Several proinflammatory cytokines have been reported to increase the permeability of intestinal mucosa in vitro. We investigated the effect of dexamethasone on gut permeability in pediatric patients undergoing cardiac surgery by using the dual sugar permeability test and absorption of 2 other saccharides.


METHODS
Thirty-four patients scheduled for cardiac surgery with cardiopulmonary bypass were prospectively randomized to either act as control subjects or to receive dexamethasone (1 mg . kg -1) during induction of anesthesia. Intestinal permeability was measured with 3-O-methyl-D-glucose, D-xylose, L-rhamnose, and lactulose administered orally after induction of anesthesia and 12 and 24 hours later.


RESULTS
Lactulose/rhamnose ratios were increased from the outset in both groups (mean 0.57 [95% confidence interval, 0.24-0.91] for the control group and 0.76 [95% confidence interval, 0.35-1.17] for patients receiving dexamethasone). Although the ratios decreased 12 hours (0.29 [95% confidence interval, 0.17-0.42]) and 24 hours later (0.17 [95% confidence interval, 0.08-0.15]) in the dexamethasone group, in the control group there was a rise at 12 hours (0.77 [95% confidence interval, 0-1.64]), with a slight reduction 24 hours later (0.46 [95% confidence interval, 0.06-0.85]).


CONCLUSIONS
Infants and children undergoing cardiac surgery with cardiopulmonary bypass show a significant reduction in gut permeability when dexamethasone is used during induction of anesthesia. Dexamethasone does not affect the intestinal barrier at the functional level, as assessed on the basis of 3-O-methyl-D-glucose and D-xylose absorption.
Malagon
Ignacio
I
Department of Anesthesia, Leiden University Medical Center, The Netherlands. jmalagon@lumc.nl
Onkenhout
Willem
W
Klok
Margreet
M
Linthorst
Lisa
L
van der Poel
Petrus F H
PF
Bovill
James G
JG
Hazekamp
Mark G
MG
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000494:pharmacology*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000494:pharmacology*; D003938:Diagnostic Techniques, Digestive System; D005260:Female; D006801:Humans; D007422:Intestines / Q000187:drug effects*; D008297:Male; D010539:Permeability / Q000187:drug effects; D011446:Prospective Studies
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone