• M Nagelschmidt, Z X Fu, S Saad, S Dimmeler, and E Neugebauer.
• Biochemical and Experimental Division, University of Cologne, Germany.
• Eur J Surg. 1999 Oct 1; 165 (10): 971-8.

ObjectiveTo assess the effect of preoperative high dose methylprednisolone on stress response and outcome.DesignRandomised, placebo-controlled, double-blind study.SettingUniversity hospital, Germany.Subjects20 patients listed for abdominal surgery of whom 10 had major intra-abdominal interventions and 10 had incisional hernias repaired.InterventionsMethylprednisolone 30 mg/kg (100 ml) was given by slow intravenous infusion 90-60 minutes before operation. The control group received the same volume of sodium chloride.Main Outcome MeasuresSpeed of convalescence, degree of fatigue, amount of pain, consumption of analgesics, breathing capacity, and hospital stay, as well as humoral and cellular mediators of the stress response.ResultsMethylprednisolone significantly improved criteria of postoperative recovery, fatigue by 47%, (day 1), convalescence by about 45% (days 1-3), and breathing capacity (FEV1) between 47% and 29% (days 5, 7) (p < 0.05, ANOVA), and led to a significant reduction of median hospital stay of 4.5 days. C-reactive protein concentration was significantly decreased (by 46% on day 3) and T-cell activation was suppressed (day 1).ConclusionOutcome of the patients after conventional abdominal surgery is substantially improved by preoperative high dose methylprednisolone. This effect is more pronounced in patients having major operations.

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