• P Tassani, J A Richter, A Barankay, S L Braun, C Haehnel, P Spaeth, H Schad, and H Meisner.
• Institute of Anesthesiology, Department of Cardiac Surgery, German Heart Center Munich at the Technical University, München.
• J. Cardiothorac. Vasc. Anesth. 1999 Apr 1;13(2):165-72.

ObjectiveTo discover the possible effects of methylprednisolone on the systemic inflammatory response during aprotinin treatment.DesignRandomized, double-blinded study.SettingUniversity-affiliated heart center.ParticipantsFifty-two patients scheduled for elective coronary artery bypass grafting.InterventionsIn the methylprednisolone group (n = 26), 1 g of methylprednisolone was administered 30 minutes before cardiopulmonary bypass (CPB). The 26 control patients received a placebo instead. High-dose aprotinin was administered to all participants.Measurements And Main ResultsAfter CPB, the concentration of the proinflammatory cytokines, interleukin-6 and interleukin-8, was significantly less in the methylprednisolone group. The anti-inflammatory interleukin-10 concentration was, in contrast, greater. After CPB, PaO2 was greater in the methylprednisolone group (245+/-17 v 195+/-16 mmHg). Dynamic pulmonary compliance was also greater, whereas the alveolar-arterial oxygen difference was less (376+/-17 v 428+/-16 mmHg). On arrival in the intensive care unit, the oxygen delivery index was greater in the methylprednisolone group (62+/-2.7 v 54+/-2.3 mL/min/m2) and the oxygen extraction rate was less (25%+/-0.02% v 30%+/-0.02%). After CPB, the cardiac index was significantly greater in the methylprednisolone group (4.1+/-0.2 v 3.6+/-0.2 L/min/m2). These patients had less blood loss postoperatively (616+/-52 v 833+/-71 mL; p = 0.017) and a greater urine output (8,015+/-542 v 6,417+/-423 mL/24 h; p = 0.024).ConclusionThe use of methylprednisolone attenuates the systemic inflammatory response during aprotinin treatment and improves clinical outcome parameters.

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