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Published on: May 9, 2013
Low incidence of early postoperative cerebral edema after coronary artery bypass grafting
Thomas H Ottens1, Jeroen Hendrikse2, Arjen J C Slooter3
1Departments of Anesthesiology.
Insights
High-dose dexamethasone did not significantly reduce early cerebral edema after coronary artery bypass grafting (CABG). Postoperative brain swelling was minimal in both dexamethasone and placebo groups, contrary to previous findings.
Area of Science:
- Neurosurgery
- Cardiology
- Pharmacology
Background:
- Coronary artery bypass grafting (CABG) can lead to early postoperative cerebral edema.
- Intraoperative dexamethasone is hypothesized to mitigate this complication.
Purpose of the Study:
- To investigate the effect of a single high dose of intraoperative dexamethasone on early cerebral edema after CABG using magnetic resonance imaging (MRI).
Main Methods:
- A secondary analysis of the Dexamethasone for Cardiac Surgery (DECS) trial involving 20 adult patients undergoing CABG with cardiopulmonary bypass.
- Patients received either a high dose of dexamethasone (1 mg/kg) or placebo intravenously at anesthesia induction.
- Cerebral edema severity was assessed immediately post-surgery via MRI.
Main Results:
- Only 1 patient in the dexamethasone group exhibited slight cerebral edema, compared to none in the placebo group (p=1.00).
- No significant difference in the severity of cerebral edema was observed between the dexamethasone and placebo groups (p=1.00).
- Median cardiopulmonary bypass time was 66 minutes for dexamethasone and 95 minutes for placebo (p=0.11).
Conclusions:
- The study did not observe significant early postoperative cerebral edema in patients undergoing CABG, regardless of dexamethasone administration.
- These findings contrast with older studies that reported a higher incidence of cerebral edema post-CABG.
Objective:
Using magnetic resonance imaging, the authors studied the influence of a single high dose of intraoperative dexamethasone on the severity of cerebral edema that can occur early after coronary artery bypass grafting (CABG). It was hypothesized that high-dose intraoperative dexamethasone reduces cerebral edema after CABG.
Design:
Secondary analysis in a subset of participants of the Dexamethasone for Cardiac Surgery (DECS) trial. The DECS trial was a multicenter, randomized, double-blind, placebo-controlled trial in 4,494 cardiac surgery patients, which studied the effect of high-dose dexamethasone on mortality and major complications after cardiac surgery.
Setting:
A large university hospital in The Netherlands.
Participants:
Twenty adult patients who underwent CABG with cardiopulmonary bypass (CPB) between March and November 2011.
Interventions:
Participants received a single intravenous dose of dexamethasone, 1 mg/kg, or placebo, at induction of anesthesia.
Measurements And Main Results:
Patients underwent magnetic resonance imaging scanning immediately after surgery. The primary outcome was the severity of cerebral edema. Data from 18 patients (9 in each group, median age 69 years in both groups) could be analyzed. Patients in the dexamethasone group were (median, interquartile range 66 (53-99) minutes on cardiopulmonary bypass v 95 (81-105) minutes in the placebo group (p = 0.11). Only 1 patient in the dexamethasone group had slight cerebral edema (0% v 11%, p = 1.00), and edema severity did not differ between groups (p = 1.00).
Conclusions:
Relevant degrees of early postoperative cerebral edema were not observed. The present study findings strongly contrasted with older studies showing cerebral edema early after CABG in most patients.
