Reduction of inflammation by high-dose methylprednisolone does not attenuate oxidative stress in children undergoing bidirectional Glenn procedure with or without aortic arch or pulmonary arterial repair

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Keski-Nisula , J , Arvola , O , Jahnukainen , T , Andersson , S & Pesonen , E 2020 , ' Reduction of inflammation by high-dose methylprednisolone does not attenuate oxidative stress in children undergoing bidirectional Glenn procedure with or without aortic arch or pulmonary arterial repair ' , Journal of Cardiothoracic and Vascular Anesthesia , vol. 34 , no. 6 , pp. 1542-1547 . https://doi.org/10.1053/j.jvca.2019.10.015

Title: Reduction of inflammation by high-dose methylprednisolone does not attenuate oxidative stress in children undergoing bidirectional Glenn procedure with or without aortic arch or pulmonary arterial repair
Author: Keski-Nisula, Juho; Arvola, Oiva; Jahnukainen, Timo; Andersson, Sture; Pesonen, Eero
Contributor: University of Helsinki, HUS Children and Adolescents
University of Helsinki, HUS Children and Adolescents
University of Helsinki, HUS Children and Adolescents
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
Date: 2020-06
Number of pages: 6
Belongs to series: Journal of Cardiothoracic and Vascular Anesthesia
ISSN: 1053-0770
URI: http://hdl.handle.net/10138/320406
Abstract: Objective Corticosteroids attenuate inflammatory reaction in pediatric heart surgery. Inflammation is a source of free oxygen radicals. Children with a cyanotic heart defect are prone to increased radical stress during heart surgery. We hypothesized that high-dose methylprednisolone reduces inflammatory reaction and thereby also oxidative stress in infants with a univentricular heart defect undergoing bidirectional Glenn procedure. Design A double-blind, placebo-controlled, randomized clinical trial. Setting Operation theatre and pediatric intensive care unit of a university hospital. Participants Twenty-nine infants undergoing bidirectional Glenn procedure with or without aortic arch or pulmonary arterial repair. Interventions After anesthesia induction, the patients received intravenously either 30 mg/kg of methylprednisolone (n=15) or the same volume of saline as placebo (n=14). Measurements and Main Results Plasma interleukin-6, interleukin-8 and interleukin-10 (biomarkers of inflammation) as well as 8-hydroxydeoxyguanosine concentrations (a biomarker of oxidative stress) were measured at four different time points: preoperatively, during CPB, after protamine administration, and six hours postoperatively. The study parameters did not differ between the study groups preoperatively. Methylprednisolone reduced the pro-inflammatory cytokines interleukin-6 and interleukin-8 and increased the anti-inflammatory cytokine interleukin-10 postoperatively. Despite reduced inflammation, there were no differences in 8-hydroxydeoxyguanosine between the methylprednisolone and placebo groups. Conclusions Pro-inflammatory reaction and increase in free radical stress were not interrelated during congenital heart surgery in cyanotic infants with a univentricular heart defect undergoing bidirectional Glenn procedure. High-dose methylprednisolone was ineffective in attenuating free radical stress.
Subject: Infant
Congenital heart defect
Bidirectional Glenn procedure
Methylprednisolone
Radical stress
Inflammation
3126 Surgery, anesthesiology, intensive care, radiology
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