Effect of timing and route of methylprednisolone administration during pediatric
cardiac surgical procedures.
Author(s): Keski-Nisula J(1), Suominen PK(2), Olkkola KT(3), Peltola K(2), Neuvonen PJ(4),
Tynkkynen P(2), Salminen JT(5), Andersson S(6), Pesonen E(7).
Affiliation(s): Author information:
(1)Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki
University Central Hospital, Helsinki, Finland. Electronic address:
juho.keski-nisula@hus.fi. (2)Department of Anesthesia and Intensive Care,
Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
(3)Department of Anesthesiology, Intensive Care, Emergency Care and Pain
Medicine, University of Helsinki and Helsinki University Central Hospital,
Helsinki, Finland. (4)Department of Clinical Pharmacology, University of Helsinki
and HUSLAB, Helsinki University Central Hospital, Helsinki, Finland.
(5)Department of Pediatric Surgery, Children's Hospital, Helsinki University
Central Hospital, Helsinki, Finland. (6)Department of Neonatal Intensive Care,
Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
(7)Department of Anaesthesiology, Intensive Care, Emergency Care and Pain
Medicine, Meilahti Hospital, Helsinki University Central Hospital, Helsinki,
Finland.
Publication date & source: 2015, Ann Thorac Surg. , 99(1):180-5
BACKGROUND: We compared the antiinflammatory and cardioprotective effects of the
two most common regimens of corticosteroid administration in pediatric cardiac
surgical procedures: a single dose delivered either at anesthesia induction or by
cardiopulmonary bypass (CPB) prime.
METHODS: Forty-five children, aged between 1 and 18 months and undergoing
ventricular septal or atrioventricular septal defect correction, were randomized
in double-blind fashion into three groups. The anesthesia induction group
received 30 mg/kg methylprednisolone intravenously after anesthesia induction,
and the CPB-prime group received 30 mg/kg methylprednisolone by CPB circuit. The
placebo group received saline solution. Plasma concentrations of
methylprednisolone, interleukin (IL)-6, IL-8 and IL-10, and troponin were
measured at anesthesia induction before the study drug, 30 minutes on CPB, after
patients were weaned from CPB, and 6 hours after cessation of CPB.
RESULTS: Equally high methylprednisolone concentrations were detected in both
methylprednisolone groups, but the measured peak concentration occurred earlier
in the induction group. Significantly lower IL-8 concentrations were observed
just after patients were weaned from and 6 hours after CPB in the anesthesia
induction group compared with the placebo (p = 0.002, p = 0.001) and prime groups
(p = 0.003, p = 0.006). Significant reductions of troponin were detected in both
methylprednisolone groups compared with placebo (induction, p = 0.001; prime, p =
0.002) 6 hours after patients were weaned from CPB.
CONCLUSIONS: Methylprednisolone administration at anesthesia induction was
superior in terms of antiinflammatory action. Methylprednisolone administration
in CPB-prime only a few minutes before aortic cross-clamping and cardioplegia
resulted in mean troponin reductions similar to those of administration at
anesthesia induction. Corticosteroids may have direct cardioprotective
properties, as reported in experimental studies.
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