Glucocorticoid effects on the inflammatory and clinical responses to cardiac surgery

Fillinger, Mary P.; Rassias, Athos J.; Guyre, Paul M.; Sanders, John H.; Beach, Michael L.; Pahl, Janice; Watson, Robert; Whalen, Patricia Kate; Yeo, Kiang-Teck J.; Yeager, Mark P.

doi:10.1053/jcan.2002.31057

Cited by 95 publications

(55 citation statements)

References 32 publications

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“…Although the indication of corticosteroids has not been established, its use can minimize postoperative changes in lung function. It has been demonstrate that methylprednisolone can reduce the production of IL-6 and increase the production of IL-10, although it does not affect the duration of mechanical ventilation or length of hospitalization after CABG 28 . In the present study, patients received steroid after anesthetic induction and we observed a significant increase in levels of IL-10 at the end of surgery, besides the negative correlation between the levels of this interleukin and reduction of lung compliance.…”

Section: Discussionmentioning

confidence: 99%

Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Machado¹,

Negri²,

Bonafé³

et al. 2011

Rev. Bras. Anestesiol.

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Section: Discussionmentioning

confidence: 99%

Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Machado¹,

Negri²,

Bonafé³

et al. 2011

Rev. Bras. Anestesiol.

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“…In patients who are undergoing cardiac surgery, acute administration of methylprednisolone reduces postoperative interleukin-6 secretion but offers no clinical benefits. [18][19][20] However, in the peripheral vasculature, normalization of elevated hsCRP concentrations over time is associated with a normalization of endothelium-mediated flow after 3 months in patients with coronary artery disease. 45 Thus, in the present study dxinduced anti-inflammatory period for 2 days might be too short to improve coronary vascular resistance in obese subjects.…”

Section: Discussionmentioning

confidence: 99%

“…15 Furthermore, reduced coronary vasoreactivity can be improved by medical interventions. 16,17 Clucocorticoids suppress secretion of inflammatory cytokines [18][19][20] and some animal studies have demonstrated beneficial effects of glucocorticoids during myocardial ischemia. 21,22 Still, clucocorticoids appear not to benefit patients undergoing coronary artery bypass grafting.…”

Section: Introductionmentioning

confidence: 99%

Short-term changes in inflammatory response protein (hsCRP) do not parallel with changes in coronary vasoreactivity in obese men

et al. 2005

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Aim: Obese subjects are characterized by increased high-sensitivity C-reactive protein (hsCRP) and coronary vascular resistance. Clucocorticoids suppress inflammation, a possible cardioprotective effect. We tested the short-term anti-inflammatory effect of dexamethasone (dx) on these parameters in obese subjects. Methods: Coronary vascular resistance was quantitated basally and during adenosine infusion with or without simultaneous euglycemic hyperinsulinemic clamp (insulin infusion rate of 1 mU/kg/min) in 11 obese and 19 age-matched nonobese males using positron emission tomography and 15 O-water. Each subject was studied both with and without previous dx treatment for 2 days (2 mg/day). Results: Before dx treatment, hsCRP concentration was significantly higher in obese than in nonobese subjects (1.5571.73 vs 0.3270.32 mg/l, P ¼ 0.005). In addition, coronary vascular resistances were higher (Po0.05) in obese than in nonobese subjects at baseline (139736 vs 117722) and during adenosine infusion without (3277 vs 2677) or with simultaneous clamp (2678 vs 2175 mmHg min g/ ml). Dx treatment decreased significantly hsCRP concentration in obese but not in nonobese subjects, leading to similar hsCRP concentrations between the groups (0.4570.43 vs 0.2670.42 mg/l, respectively, P ¼ 0.3). Dx had no effect on coronary vascular resistances (NS). Conclusions: Obese subjects are characterized by high hsCRP, which can be normalized by dx. However, despite this, coronary vascular resistances did not decrease in obese subjects. Short-term changes in inflammatory response protein appear not to parallel with changes in coronary vasoreactivity in obese men.

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“…20 As expected, several clinical trials of corticosteroids have shown an increase in the incidence of hyperglycemia as well as higher insulin requirements. 15,17,18,21,22 The Cochrane analysis did not fi nd an increased risk of infection in 15 studies including infectious complications as secondary outcomes. 5 Given that no study has been suffi ciently powered to assess this outcome, there remains a theoretical increased susceptibility to infection and poor wound healing associated with hyperglycemia that has not been elucidated in the existing studies.…”

Section: Hyperglycemia and Infectious Complicationsmentioning

confidence: 99%

Role of Corticosteroids during Cardiopulmonary Bypass

2014

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Corticosteroids are commonly used in the peri-operative setting for patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The infl ammatory response to CPB is associated with organ dysfunction and increased mortality. Corticosteroids reduce biochemical infl ammatory markers associated with CPB, however the impact on clinical outcomes is mixed. The purpose of this article is to evaluate the evidence of changes in clinical outcomes associated with the peri-operative administration of corticosteroids in patients undergoing cardiac surgery with CPB. Randomized, placebo-controlled trials and meta-analyses were reviewed for evidence evaluating the impact of corticosteroids on clinical outcomes including mortality, myocardial infarction, atrial fi brillation (AF), duration of intubation, length of intensive care unit (ICU) or hospital stay, hyperglycemia, and gastrointestinal complications. Most of the relevant studies are underpowered to assess major clinical outcomes. Although corticosteroids likely reduce the risk of AF, this needs to be evaluated when used in addition to or in lieu of other anti-arrhythmic agents. Evidence does not equivocally support the use of corticosteroids to improve clinical outcomes in cardiac surgery patients.

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Glucocorticoid effects on the inflammatory and clinical responses to cardiac surgery

Cited by 95 publications

References 32 publications

Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Short-term changes in inflammatory response protein (hsCRP) do not parallel with changes in coronary vasoreactivity in obese men

Role of Corticosteroids during Cardiopulmonary Bypass

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