British Journal of Anaesthesia, 2002, Vol. 88, No. 4 496-501
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Dexamethasone decreases the pro- to anti-inflammatory cytokine ratio during cardiac surgery
1Department of Anaesthesia and Intensive Care, Amphia Hospital, PO Box 90108, 4800 RA Breda, The Netherlands.Departments of 2Anaesthesiology and 3Intensive Care, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. 4Department of Epidemiology and Biostatistics, Erasmus Universiteit Medical School, PO Box 1738, 3000 DR Rotterdam, The Netherlands*Corresponding author
Background. Cytokines regulate inflammation associated with cardiopulmonary bypass (CPB). Pro-inflammatory cytokines may cause myocardial dysfunction and haemodynamic instability after CPB, but the release of anti-inflammatory cytokines is potentially protective. We studied the effects of dexamethasone on pro- and anti-inflammatory cytokine responses during coronary artery bypass grafting surgery.
Methods. Seventeen patients were studied: nine patients received dexamethasone 100 mg before induction of anaesthesia (group 1) and eight patients acted as controls (group 2). Plasma levels of tumour necrosis factor (TNF)-
, interleukin (IL)-6, IL-8, IL-10 and IL-4 were measured perioperatively.
Results. TNF- and IL-8 did not increase significantly in group 1 whereas they increased in group 2 to greater than preoperative values (P<0.05). IL-6 increased in both groups, with lower values in group 1 than in group 2 (P<0.05). IL-10 increased in both groups, with higher values in group 1 (P<0.05). IL-4 did not change in group 1 but decreased in group 2 compared with pre-induction values (P<0.05). After surgery, patients in group 2 had tachycardia, hyperthermia, a greater respiratory rate and higher pulmonary artery pressure, and a longer stay in the intensive care unit.
Conclusion. Dexamethasone given before cardiac surgery changes circulating cytokines in an anti-inflammatory direction. Postoperative outcome may be improved by inhibition of the systemic inflammatory response.
Br J Anaesth 2002; 88: 496–501
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