INFLUENCE OF STEROIDS ON COMPLEMENT AND CYTOKINE GENERATION AFTER CARDIOPULMONARY BYPASS

Background. It is recognized that the inflammatory mediators complemen t and cytokines are generated during cardiopulmonary bypass as an endo genous response to extracorporeal circulation. Methods. Nineteen rando mized patients (10 steroid/9 nonsteroid) entered an institutional revi ew board-approved protocol to measure complement and interleukin level generation before and after elective coronary revascularization. The steroid regimen involved Ig of methylprednisolone sodium succinate int ravenously before bypass and 4 mg of dexamethasone every 6 hours for f our doses during the first 24 hours of recovery. Complement and interl eukin levels were measured before bypass, immediately after bypass, an d at 24, 48 and 72 hours of recovery. Results. In the nonsteroid group , there was a significant elevation in all inflammatory mediators rela tive to the steroid group. The predominant changes occurred at 24 hour s after operation. Conclusions. Steroids produced a dramatic reduction in complement and interleukin levels. The number of patients was clea rly too small to document a clinical consequence of steroid administra tion.