Peroperative cardiovascular stability during brainstem surgery. The use ofhigh-dose methylprednisolone compared to dexamethasone - A retrospective analysis

Background: In neurosurgical procedures within brainstem structures, cortic osteroids are routinely administered to prevent oedema and to reduce intrao perative trauma, After replacing the routine administration of dexamethason e (DX) by high-dose methylprednisolone (MP) during surgery for tumours with in brainstem structures, a decreased incidence of intraoperative haemodynam ic instability events was observed. To test this hypothesis, a retrospectiv e analysis was performed. Methods: Peroperative data of 62 surgical procedures of brainstem tumours w ere retrospectively analysed with respect to haemodynamic instability requi ring changes in surgical strategy and/or emergence medication with vasoacti ve drugs. Severe changes in haemodynamic parameters were defined as a signi ficant increase or decrease in heart rate and/or mean arterial blood pressu re greater than 30% compared to baseline values. From 1988 to 1994, intrave nous dexamethasone was given peroperatively in 33 patients. After a bolus o f 1 mg kg(-1) body weight (BW) 30 min preoperatively, 0.2 mg kg(-1) were gi ven every 4 h. From 1994 until now, methylprednisolone was administered ins tead of dexamethasone in 29 patients. After an initial bolus of 30 mg kg(-1 ) BW immediately before surgery, 5.4 mg kg(-1) h(-1) were given 23 h postop eratively. Results: The results of this retrospective analysis suggest that the number of operations with episodes of bradycardia, arterial hypotension (P<0.05), tachycardia and arterial hypertension (P<0.005) was significantly decrease d in the group of patients treated with high-dose methylprednisolone. Conclusion: The retrospective analysis of the clinical data showed that the routine use of high-dose methylprednisolone was associated with a decrease d incidence of haemodynamic instability in a selected group of patients und ergoing brainstem surgery. This finding has to be proven in prospective dou ble-blind controlled studies. (C) Acta Anaesthesiologica Scandinavica 44 (2000).