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J Thorac Cardiovasc Surg 2001;121:561-569
© 2001 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology |
From the Department of Anesthesia and Critical Care, University of Chicago,a Chicago, Ill, the Department of Preventative Medicine and Epidemiology,b the Department of Thoracic and Cardiovascular Surgery,d Loyola University Medical Center, Maywood, Ill, and the Alexian Brothers Medical Center,c Elk Grove Village, Ill.
Supported by the Loyola University Medical Center, Department of Anesthesiology, Research Fund.
Received for publication Aug 2, 2000. Revisions requested Sept 27, 2000; revisions received Oct 2, 2000. Accepted for publication Oct 16, 2000. Address for reprints: Mark A. Chaney, MD, Department of Anesthesia and Critical Care, University of Chicago, 5841 South Maryland Ave, MC-4028, Chicago, IL 60637 (E-mail: mchaney{at}airway2.uchicago.edu).
Objective: We sought to determine whether methylprednisolone, when administered to patients undergoing cardiac surgery, is able to ward off the detrimental hemodynamic and pulmonary alterations associated with cardiopulmonary bypass.
Methods: After institutional review board approval and informed consent was obtained, 90 patients scheduled for elective cardiac surgery were randomized to 1 of 3 groups. Group 30MP patients received 30 mg/kg intravenous methylprednisolone during sternotomy and 30 mg/kg during initiation of cardiopulmonary bypass, group 15MP patients received 15 mg/kg methylprednisolone at the same 2 times, and group NS patients received similar volumes of isotonic sodium chloride solution at the same 2 times. Perioperative care was standardized, and all caregivers were blinded to treatment group. Various hemodynamic and pulmonary measurements were obtained perioperatively, as well as fluid balance, weight, peak postoperative blood glucose level, and tracheal extubation time.
Results:Demographic and clinical characteristics of patients and intraoperative data were similar among the 3 groups. Patients receiving methylprednisolone (either dose) exhibited significantly increased cardiac index (P = .0006), significantly decreased systemic vascular resistance (P = .0005), and significantly increased shunt flow (P = .0020) during the immediate postoperative period. All 3 groups exhibited significant increases in alveolar-arterial oxygen gradient (P < .0001), significant decreases in dynamic lung compliance (P < .0001), and significant decreases in static lung compliance (P < .0001) during the immediate postoperative period, with no differences between groups. Perioperative fluid balance and weights were similar between groups. A statistically significant difference in peak postoperative blood glucose level existed (P = .016) among group NS (234 ± 96 mg/dL), group 15MP (292 ± 93 mg/dL), and group 30MP (311 ± 90 mg/dL). In patients extubated within 12 hours of intensive care unit arrival, a statistically significant difference in extubation times existed (P = .025) between group NS (5.7 ± 2.3 hours), group 15MP (5.9 ± 2.2 hours), and group 30MP (7.5 ± 2.7 hours).
Conclusions: Methylprednisolone, as used in this investigation, offers no clinical benefits to patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass and may in fact be detrimental by initiating postoperative hyperglycemia and possibly hindering early postoperative tracheal extubation for undetermined reasons.
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