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J Thorac Cardiovasc Surg 1994;107:621-0621
© 1994 Mosby, Inc.

Letters to the Editor

Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass

P. D. Cooper, BSc(Hons), MBBS

Consultant Cardiothoracic Anesthetist
Freeman Hospital
High Heaton
Newcastle upon Tyne, United Kingdom

To the Editor:

Jansen and coworkers,Go 1 who contend that dexamethasone exerts a beneficial effect on patients undergoing cardiopulmonary bypass, anesthetized their study patients with etomidate. It has been known for many years that etomidate can suppress endogenous steroidogenesis.Go Go 2, 3 An alternative to these investigators' conclusions is that all patients given etomidate should also receive steroids, to counteract the effects of etomidate on endogenous steroidogenesis. The administration of dexamethasone to improve cardiovascular stability, regardless of the anesthetic used, is not supported by this work.

References

  1. Jansen NJG, van Oeveren W, vd Broeck L, et al. Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass. J THORAC CARDIOVASC SURG 1991;102:515-25.[Abstract]
  2. Wagner RL, White PF, Kan PB, Rosenthal MH, Feldman D. Inhibition of adrenal steroidogenesis by the anaesthetic etomidate. N Engl J Med 1984;310:1415-20.[Abstract]
  3. de Jong FH, Mallios C, Jansen P, Scheck PAE, Lamberts SWJ. Etomidate suppresses adrenocortical function by inhibition of 11-B hydroxylation. J Clin Endocrin Metab 1984;59:1143-7.[Abstract]




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