title: Low incidence of early postoperative cerebral edema after coronary artery bypass grafting.
abstract: OBJECTIVE
  Using magnetic resonance imaging, the authors studied the influence of a single high dose of intraoperative dexamethasone on the severity of cerebral edema that can occur early after coronary artery bypass grafting (CABG). It was hypothesized that high-dose intraoperative dexamethasone reduces cerebral edema after CABG.
  
  
  METHODS
  Secondary analysis in a subset of participants of the Dexamethasone for Cardiac Surgery (DECS) trial. The DECS trial was a multicenter, randomized, double-blind, placebo-controlled trial in 4,494 cardiac surgery patients, which studied the effect of high-dose dexamethasone on mortality and major complications after cardiac surgery.
  
  
  METHODS
  A large university hospital in The Netherlands.
  
  
  METHODS
  Twenty adult patients who underwent CABG with cardiopulmonary bypass (CPB) between March and November 2011.
  
  
  METHODS
  Participants received a single intravenous dose of dexamethasone, 1 mg/kg, or placebo, at induction of anesthesia.
  
  
  RESULTS
  Patients underwent magnetic resonance imaging scanning immediately after surgery. The primary outcome was the severity of cerebral edema. Data from 18 patients (9 in each group, median age 69 years in both groups) could be analyzed. Patients in the dexamethasone group were (median, interquartile range 66 (53-99) minutes on cardiopulmonary bypass v 95 (81-105) minutes in the placebo group (p = 0.11). Only 1 patient in the dexamethasone group had slight cerebral edema (0% v 11%, p = 1.00), and edema severity did not differ between groups (p = 1.00).
  
  
  CONCLUSIONS
  Relevant degrees of early postoperative cerebral edema were not observed. The present study findings strongly contrasted with older studies showing cerebral edema early after CABG in most patients.
authors.affiliation: Departments of Anesthesiology. Electronic address: t.h.ottens@umcutrecht.nl.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Ottens
authors.affiliation: Radiology.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hendrikse
authors.affiliation: Intensive Care Medicine.
authors.forename: Arjen J C
authors.initials: AJ
authors.lastname: Slooter
authors.affiliation: Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Lex A
authors.initials: LA
authors.lastname: van Herwerden
authors.affiliation: Departments of Anesthesiology.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Dieleman
authors.affiliation: Intensive Care Medicine.
authors.forename: Diederik
authors.initials: D
authors.lastname: van Dijk
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001929:Brain Edema / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000639:trends*; D003907:Dexamethasone / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone
keywords: CPB inflammatory response; brain imaging; brain injury; coronary artery bypass grafts; magnetic resonance imaging