Corticosteroid effect on early beta-adrenergic down-regulation durign circulatory shock: Hemodynamic study and beta-adrenergic receptor assay

SummaryThe peri-operative management of patients undergoing surgery for phaeochromocytoma or paraganglioma with calcium channel blockers (CCB) and their impact on postoperative morbidity and mortality were studied. The medical records of 105 patients undergoing surgery between 1991 and 2002 were analysed retrospectively. In all patients, the calcium channel blocker nicardipine was used for the peri-operative management of haemodynamic changes. Sixty-five patients (61.9%) showed transient intra-operative hypertension. Systolic blood pressure (SBP) > 220 mmHg and SBP > 180 mmHg for > 10 consecutive minutes was observed in 14 (13%) and four patients (2.8%), respectively. SBP < 80 mmHg for > 10 consecutive minutes occurred in 13 patients (12.3%). Eleven patients (10.4%) developed postoperative complications and three patients died (2.8%). The median (range) ICU and hospital length of stay were, respectively, 1 (0-7) day and 10 (2-35) days. The sole use of calcium channel blockers for the peri-operative management of phaeochromocytoma and paraganglioma resection does not prevent all haemodynamic changes; however, its use was associated with a low morbidity and mortality.

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“…infusion of epinephrine or norepinephrine and an i.v. bolus of methylprednisolone (10 mg.kg )1 ) were administered [4].…”

Section: Methodsmentioning

confidence: 99%

The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas

Lebuffe¹,

Dosseh

Tek³

et al. 2005

Anaesthesia

125

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“…In the near future, catecholamine refractoriness might be a target for pharmacological intervention in order to improve the b-adrenergic function in septic shock patients. Investigations demonstrating that the administration of methylprednisolone was associated with both an increased cardiac performance and a bAR up-regulation in patients with circulatory shock receiving long-term catecholamine treatment certainly merit further consideration [28].…”

Section: Mechanisms For Altered B-adrenergic Transductionmentioning

confidence: 99%

?-adrenergic receptor-dependent and -independent stimulation of adenylate cyclase is impaired during severe sepsis in humans

Bernardin¹,

Strosberg

Bernard

et al. 1998

Intensive Care Medicine

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“…[4][5][6][7][8] Several studies have involved the use of corticosteroids to reduce the systemic inflammatory process associated with the host response to sepsis and septic shock. [9][10][11][12][13][14][15][16][17][18][19][20][21] However, most of these studies involved extremely high doses over short periods (< 24 hours), and no diagnostic criteria for sepsis were applied, because such criteria were not yet well-established at that time. The results were controversial, although some authors believed in the benefit of corticosteroids after observing early shock reversal or blood pressure elevation in treated patients.…”

Section: Introductionmentioning

confidence: 99%

“…These showed improved outcomes for patients with septic shock, and also showed that methylprednisolone could be used to obtain ARDS resolution. 10,21,26,27 These recent results, as well as the unfavor-able results from using specific monoclonal antibodies, rekindle hope for the efficacy of corticosteroids in treating SIRS.…”

Section: Introductionmentioning

confidence: 99%

Effects of single dose of dexamethasone on patients with systemic inflammatory response

2006

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CONTEXT AND OBJECTIVE: Systemic inflammatory response syndrome (SIRS) is a very common condition among critically ill patients. SIRS, sepsis, septic shock and multiple organ dysfunction syndrome (MODS) can lead to death. Our aim was to investigate the efficacy of a single dose of dexamethasone for blocking the progression of systemic inflammatory response syndrome. DESIGN AND SETTING: Prospective, randomized, double-blind, single-center study in a postoperative intensive care unit (Surgical Support Unit) at Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. METHODS: The study involved 29 patients with SIRS. All eligible patients were prospectively randomized to receive either a single dose of 0.2 mg/kg of dexamethasone or placebo, after SIRS was diagnosed. The patients were monitored over a seven-day period using Sequential Organ Failure Assessment score (SOFA). RESULTS: The respiratory system showed an improvement on the first day after dexamethasone was administered, demonstrated by the improved PaO2/FiO2 ratio (p < 0.05). The cardiovascular system of patients requiring vasopressor therapy also improved over the first two days, with a better evolution in the dexamethasone group (p < 0.05). Non-surviving patients presented higher lactate assays than did survivors (p < 0.05) during this period. CONCLUSIONS: Dexamethasone enhanced the effects of vasopressor drugs and evaluation of the respiratory system showed improvements (better PaO2/FiO2 ratio), one day after its administration. Despite these improvements, the single dose of dexamethasone did not block the evolution of SIRS.

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Corticosteroid effect on early beta-adrenergic down-regulation durign circulatory shock: Hemodynamic study and beta-adrenergic receptor assay

Cited by 79 publications

References 22 publications

The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas

The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas

?-adrenergic receptor-dependent and -independent stimulation of adenylate cyclase is impaired during severe sepsis in humans

Effects of single dose of dexamethasone on patients with systemic inflammatory response

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