A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Methylprednisolone in Neonatal Cardiac Surgery: Reduced Inflammation Without Improved Clinical Outcome
Tekijät: Keski-Nisula J, Pesonen E, Olkkola KT, Peltola K, Neuvonen PJ, Tuominen N, Sairanen H, Andersson S, Suominen PK
Kustantaja: ELSEVIER SCIENCE INC
Kustannuspaikka: NEW YORK; 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA
Julkaisuvuosi: 2013
Journal: Annals of Thoracic Surgery
Tietokannassa oleva lehden nimi: Annals of Thoracic Surgery
Lehden akronyymi: Ann.Thorac.Surg.
Numero sarjassa: 6
Vuosikerta: 95
Numero: 6
Aloitussivu: 2126
Lopetussivu: 2132
Sivujen määrä: 7
ISSN: 0003-4975
DOI: https://doi.org/10.1016/j.athoracsur.2013.02.013
Tiivistelmä
Background. Corticosteroids are widely used in pediatric open-heart surgery to reduce systemic inflammatory response and to mediate possible cardioprotective effects. However, the optimal dosing of corticosteroids is unknown and their administration varies considerably between different institutions. Methods. Forty neonates undergoing open-heart surgery were randomized in a double-blind fashion equally into 2 groups. After the induction of anesthesia, 1 group received 30 mg/kg intravenous methylprednisolone and the other a placebo. Concentrations in plasma of interleukin 6 (IL-6), IL-8, IL-10, free methylprednisolone and total methylprednisolone were obtained for the following: (1) at anesthesia induction before the study drug was administered; (2) 30 minutes on cardiopulmonary bypass; (3) 5 minutes after protamine administration; and (4) 6 hours after weaning from cardiopulmonary bypass. Troponin T was measured at time points T1, T3, T4, and also at 6: 00 on the first postoperativemorning. Physiological and clinical outcome parameters were also recorded. Results. Intravenous methylprednisolone resulted in high plasma drug concentrations that peaked at T2. Methylprednisolone significantly lowered concentrations of proinflammatory cytokines IL-6 and IL-8 and raised levels of anti-inflammatory IL-10. No significant differences in troponin T levels were detected. Blood glucose levels were significantly higher in the methylprednisolone group, and patients in this group received more often insulin therapy than controls. No significant differences were observed in other clinical or physiological outcome measurements. Conclusions. Intravenous 30 mg/kg methylprednisolone administered before cardiopulmonary bypass resulted in high effective plasma drug concentrations and a decreased inflammatory response. However, no cardioprotective effect or better clinical outcome was noticed. (C) 2013 by The Society of Thoracic Surgeons
Background. Corticosteroids are widely used in pediatric open-heart surgery to reduce systemic inflammatory response and to mediate possible cardioprotective effects. However, the optimal dosing of corticosteroids is unknown and their administration varies considerably between different institutions. Methods. Forty neonates undergoing open-heart surgery were randomized in a double-blind fashion equally into 2 groups. After the induction of anesthesia, 1 group received 30 mg/kg intravenous methylprednisolone and the other a placebo. Concentrations in plasma of interleukin 6 (IL-6), IL-8, IL-10, free methylprednisolone and total methylprednisolone were obtained for the following: (1) at anesthesia induction before the study drug was administered; (2) 30 minutes on cardiopulmonary bypass; (3) 5 minutes after protamine administration; and (4) 6 hours after weaning from cardiopulmonary bypass. Troponin T was measured at time points T1, T3, T4, and also at 6: 00 on the first postoperativemorning. Physiological and clinical outcome parameters were also recorded. Results. Intravenous methylprednisolone resulted in high plasma drug concentrations that peaked at T2. Methylprednisolone significantly lowered concentrations of proinflammatory cytokines IL-6 and IL-8 and raised levels of anti-inflammatory IL-10. No significant differences in troponin T levels were detected. Blood glucose levels were significantly higher in the methylprednisolone group, and patients in this group received more often insulin therapy than controls. No significant differences were observed in other clinical or physiological outcome measurements. Conclusions. Intravenous 30 mg/kg methylprednisolone administered before cardiopulmonary bypass resulted in high effective plasma drug concentrations and a decreased inflammatory response. However, no cardioprotective effect or better clinical outcome was noticed. (C) 2013 by The Society of Thoracic Surgeons
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