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Corticosteroids during operations using cardiopulmonary bypass.

P Tassani1

  • 1Institute for Anesthesiology, German Heart Center, Clinic of the Technical University of Munich, Munich, Germany. Tassani@dhm.mhn.de

Journal of Clinical Anesthesia
|June 28, 2000
PubMed
Summary

Corticosteroids may reduce inflammation during cardiopulmonary bypass (CPB), but their routine use remains debated due to controversial clinical effects and potential side effects. Patient-specific recommendations are needed.

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Area of Science:

  • Cardiovascular Surgery
  • Pharmacology
  • Immunology

Background:

  • Corticosteroids have been utilized in extracorporeal circulation for over three decades.
  • Methylprednisolone was historically administered during cardiopulmonary bypass (CPB) to mitigate vasoconstriction and prevent low output syndrome.
  • Lipid mediators are known to induce vasoconstriction and inflammatory cytokine release during CPB.

Purpose of the Study:

  • To review the ongoing debate regarding the benefits and drawbacks of routine corticosteroid administration during CPB.
  • To explore the mechanisms by which corticosteroids influence inflammatory and anti-inflammatory mediators.
  • To analyze the controversial clinical outcomes and side effects associated with corticosteroid use in CPB.

Main Methods:

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  • Literature review and analysis of existing studies on corticosteroid use during CPB.
  • Examination of the biochemical pathways involving lipid mediators, cytokines, and corticosteroids.
  • Assessment of reported clinical parameters, including pulmonary oxygenation and blood glucose levels.

    • Main Results:

    • Corticosteroids demonstrate a clear capacity to modulate inflammatory and anti-inflammatory mediators.
    • Reported effects on clinical parameters such as pulmonary oxygenation are contradictory.
    • A consistent, though clinically insignificant, increase in blood glucose levels was observed.

    Conclusions:

    • The routine application of corticosteroids during CPB is not definitively established due to conflicting clinical evidence.
    • The influence of concomitant medications affecting the inflammatory response necessitates consideration.
    • A personalized approach to corticosteroid use during CPB operations is recommended based on individual patient factors.