• Sheri S Crow, William C Oliver, Jamie A Kiefer, Melissa R Snyder, Joseph A Dearani, Zhuo Li, and Harold M Burkhart.
• Division of Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minn. Electronic address: Crow.sheri@mayo.edu.
• J. Thorac. Cardiovasc. Surg.. 2014 Jan 1;147(1):475-81.

ObjectivesWe sought to evaluate whether there is variability in blood dexamethasone levels after a standard 1 mg/kg dose of dexamethasone administered before infant cardiopulmonary bypass. We hypothesized that postoperative dexamethasone drug levels are highly variable, and that the infant stress response is related inversely to the amount of dexamethasone measured in the blood.MethodsThirty-two infants (age, ≤365 days) received 1 mg/kg of dexamethasone before cardiopulmonary bypass (CPB) initiation. Blood was analyzed for cortisol, adrenocorticotropin, and interleukin (IL)-6, IL-8, and IL-10 levels after anesthesia induction, after CPB, after intensive care unit (ICU) arrival, and 4, 8, 12, and 24 hours after surgery. Patients were grouped as high dexamethasone (≥15 μg/dL) or low dexamethasone (<15 μg/dL) based on their level at ICU arrival.ResultsDexamethasone levels varied significantly between the high (n = 22) and low (n = 10) dexamethasone groups throughout the entire postoperative course and were correlated highly with cortisol response. Patients with high dexamethasone levels had postoperative cortisol levels that were lower than their pre-CPB baseline cortisol levels. Cortisol levels remained low throughout the first 24 postoperative hours even after dexamethasone levels neared zero. There were no significant differences between groups in the duration of mechanical ventilation or ICU length of stay.ConclusionsDexamethasone levels are highly variable at ICU arrival, despite standardized 1 mg/kg dosing before CPB initiation.Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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