GLUCOCORTICOID ATTENUATES A DECREASE OF ANTITHROMBIN-III FOLLOWING MAJOR SURGERY

Background. Major surgery, such as esophagectomy, activates inflammato ry responses and the coagulation system, and this activation is charac terized by release of inflammatory cytokines and a decrease in antithr ombin-III (AT-III), respectively. Preoperative glucocorticoid administ ration has been reported to suppress circulatory cytokine levels after major surgery. Patients and methods. A total of 28 patients underwent esophagectomy for esophageal carcinoma; 14 of them were given 10 mg/k g of methylprednisolone intravenously upon induction of anesthesia and 14 served as controls. Circulating levels of tumor necrosis factor-al pha (TNF-alpha), interleukin 6 (IL-6), polymorphonuclear (PMN) elastas e, thrombin-antithrombin III complex (TAT), AT-III, and albumin were m easured before and immediately after the operation and on postoperativ e days (PODs) 1, 3, 5, and 7. Results. TNF-alpha, IL-6, and TAT levels significantly increased after esophagectomy in both groups. AT-III an d albumin decreased to their minimum levels on POD I and POD 3, respec tively. Methylprednisolone treatment effectively inhibited the increas es in TNF-alpha and IL-6 and the decreases in AT-III and albumin, but did not inhibit the increases in PMN-elastase and TAT levels. There we re significant correlations between AT-III, IL-6, and albumin levels. Conclusions. These results suggest that methylprednisolone pretreatmen t attenuates the decrease in AT-HI by reducing IL-6 production postope ratively. (C) 1998 Academic Press.