title: Investigating the Impacts of Preoperative Steroid Treatment on Tumor Necrosis Factor-Alpha and Duration of Extubation Time underwent Ventricular Septal Defect Surgery.
abstract: BACKGROUND
  Cardiopulmonary bypass is known to cause inflammatory events. Inflammation occurs due to many known important biological processes. Numerous mechanisms are known to be responsible for the development of inflammatory processes. Currently, there are many defined mediators as a tumor necrosis factor-α (TNF-α) playing an active role in this process.
  
  
  OBJECTIVE
  This research was to investigate the effects of pre-operative steroid use on inflammatory mediator TNF-α and on time to extubation postoperatively in ventricular septal defect patients undergoing cardiopulmonary bypass surgery.
  
  
  METHODS
  Controlled clinical study.
  
  
  METHODS
  This study included 30 patients. These patients were assigned into two groups, each containing 15 patients. 5 micrograms/kg methylprednisolone was injected intravenously 2 hours before the surgery to Group I, whereas there was no application to the patients in Group II. TNF-α (pg/mL) level was measured in arterial blood samples obtained at four periods including: the preoperative period (Pre TNF); at the 5(th) minute of cross-clamping (Per TNF); 2 hours after termination of cardiopulmonary bypass (Post TNF); and at the postoperative 24th hours in cardiovascular surgery intensive care unit (Post 24 h TNF).
  
  
  RESULTS
  The mean cross-clamp time was 66±40 and 55±27 minutes in Group I and Group II respectively. No significant difference was found between the groups in terms of cross-clamp time (p>0.05). The mean time to extubation was 6.1±2.3 hours in Group I and 10.6±3.4 hours in Group II. Group I extubation time was significantly shorter than Group II. Group I TNF-α levels at Post TNF and Post24h TNF was lower than Group II. These differences are also statistically significant (p<0.05).
  
  
  CONCLUSIONS
  There is a strong indication that preoperative steroid treatment reduced the TNF-α level together with shortens duration of postoperative intubation and positively contributes to extubation in ventricular septal defect patients operated in cardiac surgery with cardiopulmonary bypass. (ClinicalTrials.gov Identifier: TCTR20150930001).
authors.affiliation: Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey.
authors.forename: H Hakan
authors.initials: HH
authors.lastname: Poyrazoğlu
authors.affiliation: Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey.
authors.forename: Zeynel
authors.initials: Z
authors.lastname: Duman
authors.affiliation: Department of Cardiology, Adana State Hospital, Adana, Turkey.
authors.forename: Şerafettin
authors.initials: Ş
authors.lastname: Demir
authors.affiliation: Department of Cardiovascular Surgery, Medicana International Hospital, İstanbul, Turkey.
authors.forename: M Kemal
authors.initials: MK
authors.lastname: Avşar
authors.affiliation: Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey.
authors.forename: Atakan
authors.initials: A
authors.lastname: Atalay
authors.affiliation: Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey.
authors.forename: Bahattin
authors.initials: B
authors.lastname: Çiftçi
authors.affiliation: Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey.
authors.forename: İhsan
authors.initials: İ
authors.lastname: Bayraktar
authors.affiliation: Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey.
authors.forename: Funda
authors.initials: F
authors.lastname: Tor
keywords: Airway extubation; cardiopulmonary bypass; congenital heart defect; methylprednisolone; tumor necrosis factor-α