Dexamethasone decreases the pro- to anti-inflammatory cytokine ratio during cardiac surgery

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-...

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Bibliographic Details
Published in:	British journal of anaesthesia : BJA Vol. 88; no. 4; pp. 496 - 501
Main Authors:	El Azab, S.R., Rosseel, P.M.J., de Lange, J.J., Groeneveld, A.B.J., van Strik, R., van Wijk, E.M., Scheffer, G.J.
Format:	Journal Article
Language:	English
Published:	Oxford Elsevier Ltd 01-04-2002 Oxford University Press Oxford Publishing Limited (England)
Subjects:	Aged analgesics anti-inflammatory, steroid, dexamethasone Anesthesia Anesthesia depending on type of surgery Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Inflammatory Agents - pharmacology Biological and medical sciences Cardiopulmonary Bypass - adverse effects Cytokines - blood Cytokines - drug effects Dexamethasone - pharmacology Female Humans Inflammation - prevention & control Interleukin-10 - blood Interleukin-4 - blood Interleukin-6 - blood Interleukin-8 - blood Length of Stay Male Medical sciences Middle Aged Postoperative Complications - prevention & control Preoperative Care - methods protein, cytokine Thoracic and cardiovascular surgery. Cardiopulmonary bypass Tumor Necrosis Factor-alpha - metabolism protein, cytokine analgesics anti-inflammatory, steroid, dexamethasone analgesics anti‐inflammatory, steroid, dexamethasone; protein, cytokine Human Corticosteroid Dexamethasone Antiinflammatory agent Cytokine Cardiovascular disease General anesthesia Inflammation Coronary heart disease Cardiopulmonary bypass Interleukin 6 Interleukin 4 Aortocoronary Bypass Surgery Interleukin 10 Tumor necrosis factor α Interleukin 8
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Summary:	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. 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)-α, interleukin (IL)-6, IL-8, IL-10 and IL-4 were measured perioperatively. TNF-α 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. 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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23
ISSN:	0007-0912 1471-6771
DOI:	10.1093/bja/88.4.496