title: Effect of timing and route of methylprednisolone administration during pediatric cardiac surgical procedures.
abstract: BACKGROUND
  We compared the antiinflammatory and cardioprotective effects of the two most common regimens of corticosteroid administration in pediatric cardiac surgical procedures: a single dose delivered either at anesthesia induction or by cardiopulmonary bypass (CPB) prime.
  
  
  METHODS
  Forty-five children, aged between 1 and 18 months and undergoing ventricular septal or atrioventricular septal defect correction, were randomized in double-blind fashion into three groups. The anesthesia induction group received 30 mg/kg methylprednisolone intravenously after anesthesia induction, and the CPB-prime group received 30 mg/kg methylprednisolone by CPB circuit. The placebo group received saline solution. Plasma concentrations of methylprednisolone, interleukin (IL)-6, IL-8 and IL-10, and troponin were measured at anesthesia induction before the study drug, 30 minutes on CPB, after patients were weaned from CPB, and 6 hours after cessation of CPB.
  
  
  RESULTS
  Equally high methylprednisolone concentrations were detected in both methylprednisolone groups, but the measured peak concentration occurred earlier in the induction group. Significantly lower IL-8 concentrations were observed just after patients were weaned from and 6 hours after CPB in the anesthesia induction group compared with the placebo (p = 0.002, p = 0.001) and prime groups (p = 0.003, p = 0.006). Significant reductions of troponin were detected in both methylprednisolone groups compared with placebo (induction, p = 0.001; prime, p = 0.002) 6 hours after patients were weaned from CPB.
  
  
  CONCLUSIONS
  Methylprednisolone administration at anesthesia induction was superior in terms of antiinflammatory action. Methylprednisolone administration in CPB-prime only a few minutes before aortic cross-clamping and cardioplegia resulted in mean troponin reductions similar to those of administration at anesthesia induction. Corticosteroids may have direct cardioprotective properties, as reported in experimental studies.
authors.affiliation: Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: juho.keski-nisula@hus.fi.
authors.forename: Juho
authors.initials: J
authors.lastname: Keski-Nisula
authors.affiliation: Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Pertti K
authors.initials: PK
authors.lastname: Suominen
authors.affiliation: Department of Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Klaus T
authors.initials: KT
authors.lastname: Olkkola
authors.affiliation: Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Kaija
authors.initials: K
authors.lastname: Peltola
authors.affiliation: Department of Clinical Pharmacology, University of Helsinki and HUSLAB, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Pertti J
authors.initials: PJ
authors.lastname: Neuvonen
authors.affiliation: Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Tynkkynen
authors.affiliation: Department of Pediatric Surgery, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Jukka T
authors.initials: JT
authors.lastname: Salminen
authors.affiliation: Department of Neonatal Intensive Care, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Sture
authors.initials: S
authors.lastname: Andersson
authors.affiliation: Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Meilahti Hospital, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Eero
authors.initials: E
authors.lastname: Pesonen
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004311:Double-Blind Method; D006343:Heart Septal Defects / Q000601:surgery*; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D008775:Methylprednisolone / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone