Comparison Between Preoperative Administration of Methylprednisolone With its Administration Before and During Congenital Heart Surgery on Serum Levels of IL-6 And IL-10

Abstract

Background: Steroid administration during cardiopulmonary bypass is considered to improve cardiopulmonary function by modulating inflammations caused by bypass. Objectives: This study was performed to compare effectiveness of preoperative and intraoperative methylprednisolone (MP) to preoperative methylprednisolone alone in post bypass inflammatory (IL-6) and anti-inflammatory (IL-10) factors. Patients and Methods: Fifty pediatric patients undergoing cardiopulmonary bypass surgery from August 2011 to 2012 in the cardiac surgery department of Imam Reza Hospital, the major center for CPB, in Mashhad, Iran were randomly assigned to receive preoperative and intraoperative MP (30 mg/kg, 4 hours before bypass and in bypass prime, number 25) or preoperative MP only (30 mg/kg, number 25). Before and after bypass, four and 24 hours after bypass, serum IL-6 and IL-10 were measured by ELISA. Results: In both groups, no significant difference with variation of expression for IL-6 (inflammatory factor) and IL-10 (anti-inflammatory factor) in different times after bypass was observed. Conclusions: No significant difference in reducing post bypass inflammation between preoperative steroid treatment and combined preoperative and intraoperative steroid administration reported and they had the same effects.

Perioperative Corticosteroid Therapy in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

“…However, the infection episodes and maximal temperature in the first 24 h postoperatively were similar between groups as well as LOIS and mortality. We must admit that the studies included enrolled patients with different conditions, especially for the three (10,17,20) of them, in which only patients undergoing simple congenital heart surgeries were enrolled. These three studies played important roles on assessing the infection episodes and maximal temperature in the first 24 h postoperatively, which might be the reason for the high heterogeneity between studies in the assessment above.…”

“…However, as we all know, neonates were of great difference in physiology from elder children, which reduced the generalization of the results. Meanwhile, three studies (10,17,20) we included only enrolled patients undergoing simple congenital heart surgeries with shorter CPB duration, which might complicate the results. Third, the 30-mg/kg dose of methylprednisolone was too much for clinical practice in some institutions.…”

“…However, some potential adverse effects may be associated with corticosteroids, for example, hyperglycemia, poor wound healing, infections, and poor neurodevelopmental outcomes (6)(7)(8). Several small, randomized, controlled studies in pediatric patients have investigated the effect of perioperative corticosteroids on the inflammatory biomarkers, clinical outcomes, and adverse events after congenital heart surgeries (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Nevertheless, the results were conflicted, resulting in the controversy over perioperative corticosteroids.…”