Preoperative administration of steroids: Influence on adhesion molecules and cytokines after cardiopulmonary bypass

Background. Cardiopulmonary bypass (CPB) is associated with tissue damage m ediated by adhesion molecules and cytokines. Prebypass steroid administrati on may modulate the inflammatory response, resulting in improved postoperat ive recovery. Methods. Fifty patients undergoing elective coronary operations under normo thermic CPB were randomized into two groups: group A (n = 24) received intr avenous methylprednisolone (10 mg/kg) 4 hours preoperatively, and group B ( n = 26) served as controls. Cytokines (tumor necrosis factor-alpha [TNF-alp ha], interleukin-2R [IL-2R], IL-6, IL-8), soluble adhesion molecules (sE-se lectin, sI-CAM-1), C-reactive protein, and leukocytes were measured before steroid application, then 24 and 48 hours, and 6 days postoperatively. Adhe sion molecules were measured by enzyme-linked immunosorbent assay, cytokine s by chemiluminescent immunoassay. Postoperatively, hemodynamic measurement s, inotropic agent requirements, blood loss, duration of mechanical ventila tion, and intensive care unit stay were compared. Results. Aortic cross-clamp and CPB time was similar in both groups. Predni solone administration reduced postoperative levels of IL-6 (611 versus 92.7 pg/mL, p = 0.003), TNF-alpha (24.4 versus 11.0 pg/L, p = 0.02), and E-sele ctin (327 versus 107 ng/mL, p = 0.02). Postoperative recovery did not diffe r between groups. Conclusions. Preoperative administration of methylprednisolone blunted the increase of IL-6, TNF-alpha, and E-selectin levels after CPB but had no mea surable effect on postoperative recovery. (C) 2001 by The Society of Thorac ic Surgeons.