Effects of dexamethason on the early postoperative course after coronary artery bypass surgery

The effects of dexamethason (DM) on the postoperative course of coronary artery bypass have been investigated in a double blind study. Twenty patients receiving dexamethason 1 mg/kg body weight intravenously (IV) before cardiopulmonary bypass are compared with a control group of 20 patients receiving placebo. In the treated group core temperature remained normal (maximum 37.6 +/- 0.5 degrees C) while in the control group the patients regularly developed fever (39.0 +/- 0.7 degrees C; p less than 0.01). In the DM-treated group a significantly higher blood pressure, and a lower incidence of rhythm disorders were found. There was a marked difference in the fluid requirements between the 2 groups. Without DM the fluid balance was 2,300 cc positive at the end of the study, in the treatment group this excess was only 1,000 cc (p less than 0.001). Dexamethason treatment also led to higher urine output (130 cc/hr, vs. 85 cc/hr). Although the arterial oxygen tension was higher in the treated group, no patient developed respiratory insufficiency in the control group. The post-pump syndrome is re-evaluated and possible mechanisms are discussed.