The effects of methylprednisolone on complement, immunoglobulins and pulmonary neutrophil sequestration during cardiopulmonary bypass

In this study, the authors administered high dose (30 mg/kg body weight i.v .) methylprednisalone before cardiopulmonary bypass to observe the effects on complement, immunoglobulins and pulmonary neutrophil sequestration. Fift y patients undergoing valve replacements were included in this study. Patie nts were divided into two groups: group I (20 patients) served as control a nd did not receive methylprednisolone, group II (30 patients) received meth ylprednisolone. Blood samples for complements (C3c and C4) were taken, befo re cardiopulmonary bypass, at 5, 10 and 30 min intervals from the end of ca rdiopulmonary bypass, after reversal of heparin with protamine infusion, an d after skin closure. Blood samples for immunoglobulins were taken before c ardiopulmonary bypass, 30 min after onset of cardiopulmonary bypass and aft er skin closure. After onset of cardiopulmonary bypass, all C3c and C4 leve ls decreased in both groups. There was a significant decrease in C4 levels at end of cardiopulmonary bypass and after protamine infusion in group I co mpared with group II (P < 0.05). C3c levels in group I decreased significan tly compared with group II after 30 min of cardiopulmonary bypass and after protamine infusion (P < 0.05). All immunoglobulin (IgG, IgM, IgA) levels w ere decreased in both groups, but the decrease in IgG was statistically sig nificant after skin closure in group I compared with group II (P < 0.05). P ulmonary neutrophil sequestration was higher in the control group compared with the methyl-prednisolone group (P < 0.05), In conclusion, methylprednis olone administration before cardiopulmonary bypass may prevent the harmful effects of complement activation, immunoglobulin denaturation and neutrophi l sequestration in the pulmonary capillary system. (C) 1999 The Internation al Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. A ll rights reserved.