Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass

Jansen, NJ; W, van Oeveren; L, van den Broek; Hm, Oudemans-van Straaten; Stoutenbeek, C. P.; Mc, Joen; Kj, Roozendaal; Eysman, L.; Cr, Wildevuur

doi:10.1016/s0022-5223(20)31421-5

Cited by 194 publications

(39 citation statements)

References 24 publications

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“…Our results can only partly con®rm the improvements of clinical outcome found in previous investigations, 8 19 25 26 which may explain the shorter stay in the ICU in our study and in that of Jansen and colleagues. 8 We conclude that dexamethasone before cardiac surgery shifts the circulating cytokine pro®le towards the anti-in¯ammatory responses and may improve the postoperative course by inhibition of the systemic in¯ammatory response. Future studies should consider the correlation between circulating cytokines and clinical course.…”

Section: Discussionmentioning

confidence: 78%

Dexamethasone decreases the pro- to anti-inflammatory cytokine ratio during cardiac surgery

Azab

Rosseel

Lange

et al. 2002

British Journal of Anaesthesia

123

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Section: Discussionmentioning

confidence: 78%

Dexamethasone decreases the pro- to anti-inflammatory cytokine ratio during cardiac surgery

Azab

Rosseel

Lange

et al. 2002

British Journal of Anaesthesia

123

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“…A total of 42 randomized controlled trails involving 7621 participants were identified and included in the meta‐analysis (Figure ) . All studies were published in English.…”

Section: Resultsmentioning

confidence: 99%

The Efficacy of Glucocorticoids for the Prevention of Atrial Fibrillation, or Length of Intensive Care Unite or Hospital Stay After Cardiac Surgery: A Meta‐Analysis

Liu

Wang

Yiu

et al. 2014

Cardiovascular Therapeutics

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SUMMARYAims: cardiopulmonary bypass and cardiac surgery are associated with a significant systemic inflammatory response that has been suggested playing a causative role in the development of perioperative atrial fibrillation (POAF). The goal of this meta-analysis was to determine the efficacy of glucocorticoid prophylaxis in preventing POAF, or length of intensive care unite (ICU) or hospital stay. Methods: A systematic electronic database literature search of Cochrane controlled trials register (2013, issue 4) and MEDLINE (1966 to April, 2013 was conducted using specific search terms for all relevant articles. Including criteria were: randomized controlled clinical trials, participants were adults (≥18 years of age) undergoing cardiac surgery, evaluated glucocorticoid prophylaxis in cardiac surgery with adequately reported data on incidence of POAF, or length of ICU or hospital stay. Results: Forty-two randomized controlled trials involving 7621 participants were included in the meta-analysis. Overall, glucocorticoids prophylaxis significantly lowered participants' risk of developing POAF (Relative Risk [RR] 0.77; 95% confidence interval [CI] 0.66-0.90), P < 0.01), reduced length of ICU stay by 0.25 day (95% CI À0.40 to À0.10, P < 0.01). Glucocorticoid prophylaxis in cardiac surgery was not associated with increased all-cause of infection (RR 0.68; 95% CI 0.58-0.78, P < 0.01) and mortality (RR 0.75; 95% CI 0.52-1.08, P = 0.12). Conclusions: Pooled evidence suggests that glucocorticoid prophylaxis may reduce the incidence of POAF. The beneficial effect on POAF is associated with reduced length of ICU and hospital stay, and infection rate.

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“…TNF‐α, a monocyte‐derived cytokine, is known to play a central role in the development of the whole body inflammatory response syndrome regardless of its etiology. TNF‐α is a powerful inflammatory mediator released by activated leukocytes (20,21) and is currently considered one of the main factors generating fever and causing postoperative morbidity after CPB (22). Gu et al showed reduced generation of TNF‐α in using heparin‐coated circuits in CPB (7).…”

Section: Discussionmentioning

confidence: 99%

Effects of Duraflo II Heparin‐Coated Cardiopulmonary Bypass Circuits on the Coagulation System, Endothelial Damage, and Cytokine Release in Patients with Cardiac Operation Employing Aprotinin and Steroids

et al. 1999

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The effects of Duraflo II heparin coated cardiopulmonary bypass circuits, low-dose aprotinin, and steroids on the coagulation system, endothelial damage, and cytokine release were evaluated by comparing those treated with low-dose aprotinin and steroids. Twenty-four adult patients undergoing coronary artery bypass grafting, aortic valve replacement, or valve repair surgery were randomly assigned to 2 groups: either heparin-coated (Duraflo group, n = 12) or noncoated equipment (noncoated group, n = 12) groups. In the Duraflo group, the cardiopulmonary reservoir was also coated with heparin. There were no significant differences in age at the time of operation, aortic cross-clamp time, cardiopulmonary bypass time, and rectal temperature during cardiopulmonary bypass. Standard systemic heparinization was performed. Methylpredonisolone and low-dose aprotinin were given in both groups of patients. Serum XIIa factor, TAT, and IL-6 were significantly higher in the control group than in the Duraflo group during cardiopulmonary bypass (p < 0.01). Serum IL-8 was significantly higher in the control group than in the Duraflo group at 24 h after cardiopulmonary bypass (p < 0.05). No significant difference was found in serum thrombomodulin and TNF-alpha; both were within normal during the study period. These results indicate that the use of Duraflo II heparin coated equipment and a heparin-coated cardiopulmonary reservoir suppressed excess coagulation and inflammatory reaction induced by cardiopulmonary bypass.

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Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass

Cited by 194 publications

References 24 publications

Dexamethasone decreases the pro- to anti-inflammatory cytokine ratio during cardiac surgery

Dexamethasone decreases the pro- to anti-inflammatory cytokine ratio during cardiac surgery

The Efficacy of Glucocorticoids for the Prevention of Atrial Fibrillation, or Length of Intensive Care Unite or Hospital Stay After Cardiac Surgery: A Meta‐Analysis

Effects of Duraflo II Heparin‐Coated Cardiopulmonary Bypass Circuits on the Coagulation System, Endothelial Damage, and Cytokine Release in Patients with Cardiac Operation Employing Aprotinin and Steroids

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