title: Comparing the effect of preoperative administration of methylprednisolone and its administration before and during surgery on the clinical outcome in pediatric open heart surgeries.
abstract: BACKGROUND
  Cardiac surgery under Cardiopulmonary bypass causes a systemic inflammatory response with a multifactorial etiology including direct tissue damage, ischemia and stimulation of immune system induced by cardiopulmonary bypass. This study was designed due to the high prevalence and complications of this stimulated immune system in mortality, morbidity, length of ICU stay, and mechanical ventilation.
  
  
  OBJECTIVE
  This study was aimed to compare preoperative and intraoperative methylprednisolone (MP) to intraoperative MP alone with respect to postbypass inflammation and clinical outcome.
  
  
  METHODS
  Sixty pediatric patients (age < 5years) undergoing cardiopulmonary bypass surgery between September 2011-2012 at Imam Reza hospital-Mashhad were randomly assigned to receive preoperative and intraoperative MP (group 1: 30 mg/kg, 4 hours before bypass and in bypass prime, n = 30) or intraoperative MP only (group 2: 30 mg/kg, n = 30). Postoperative temperature (peak temperature and average temperature during the first 24 hours), amount of inotropic, duration of mechanical ventilation, ICU stay, WBC, BUN, creatinine, and CRP were recorded and compared in both groups. Data were analyzed with SPSS version 13 by T-test, Mann-Whitney test if necessary, and Chi-squared distribution.
  
  
  RESULTS
  Patient characteristics including age, weight, gender, and duration of bypass were almost similar in both groups (P > 0.05). No significant difference in amount of inotropic medications used for hemodynamic supports, duration of mechanical ventilation, peak and average temperature and length of ICU stay was observed. Among the laboratory tests (WBC, BUN, creatinine, CRP) only WBC counts raised more in group 2 when compared to group 1(P < 0.05).
  
  
  CONCLUSIONS
  There was no difference in clinical outcome after cardiac surgery when we administered an additional dose of methylprednisolone compared to a single dose of methylprednisolone.
authors.affiliation: Department of Anesthesiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Ghasem
authors.initials: G
authors.lastname: Soltani
authors.affiliation: Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abbasi Tashnizi
authors.affiliation: Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Ali Asghar
authors.initials: AA
authors.lastname: Moeinipour
authors.affiliation: Department of Anesthesiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ganjifard
authors.affiliation: Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Jamil
authors.initials: J
authors.lastname: Esfahanizadeh
authors.affiliation: Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Sepehri Shamloo
authors.affiliation: Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Seyed Javad
authors.initials: SJ
authors.lastname: Purafzali Firuzabadi
authors.affiliation: Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Zirak
keywords: Cardiopulmonary Bypass; Congenital; Heart Defects; Inflammation