THE EFFECT OF PREOPERATIVE HIGH-DOSE METHYLPREDNISOLONE IN ATTENUATING THE METABOLIC RESPONSE AFTER ESOPHAGEAL RESECTION

Objective: To evaluate the effect of giving glucocorticoids preoperati vely for the prophylaxis of surgical stress. Design: Prospective rando mised study. Setting: University hospital, Japan. Subjects: 30 patient s undergoing resection of oesophageal carcinoma. Interventions: 15 pat ients (group 1) were randomised to be given methylprednisolone (30 mg/ kg) and 15 patients (group 2) to be given saline intravenously before operation. Main outcome measures: Outcome, length of stay in the inten sive care unit (ICU), metabolic response, and oxygenation. Results: Pa tients given methylprednisolone had a mean stay in the ICU of 5.1 +/- 1.0 days compared with 8.2 +/- 4.5 days in the saline group (p < 0.01) . 5 patients in the saline group compared with 0 in the methylpredniso lone group developed postoperative complications (p = 0.02). Plasma no repinephrine and arginine vasopressin levels in methylprednisolone gro up were significantly lower than those in the saline group (p < 0.05). The PaO2:FiO(2) ratio in the saline group was significantly lower tha n that in the experimental group (p < 0.01). Conclusion: Preoperative methylprednisolone may facilitate the postoperative management of surg ical patients.