Investigating the Impacts of Preoperative Steroid Treatment on Tumor Necrosis Factor-Alpha and Duration of Extubation Time underwent Ventricular Septal Defect Surgery

Year 2016, Volume: 33 Issue: 2, 158 - 163, 01.03.2016

H.hakan Poyrazoğlu Zeynel Duman Şerafettin Demir Atakan Atalay Bahattin Çiftçi İhsan Bayraktar Funda Tor Şerafettin Demir M.kemal Avşar

Abstract

Background: Cardiopulmonary bypass is known to cause inflammatory events. Inflammation occurs due to many known important biological processes. Numerous mechanisms are known to be responsible for the development of inflammatory processes. Currently, there are many defined mediators as a tumor necrosis factor-α (TNF-α) playing an active role in this process. Aims: This research was to investigate the effects of preoperative steroid use on inflammatory mediator TNF-α and on time to extubation postoperatively in ventricular septal defect patients undergoing cardiopulmonary bypass surgery.  Study Design: Controlled clinical study. Methods: This study included 30 patients. These patients were assigned into two groups, each containing 15 patients. 5 micrograms/kg methylprednisolone was injected intravenously 2 hours before the surgery to Group I, whereas there was no application to the patients in Group II. TNF-α (pg/mL) level was measured in arterial blood samples obtained at four periods including: the preoperative period (Pre TNF); at the 5th minute of cross-clamping (Per TNF); 2 hours after termination of cardiopulmonary bypass (Post TNF); and at the postoperative 24th hours in cardiovascular surgery intensive care unit (Post 24 h TNF).  Results: The mean cross-clamp time was 66±40 and 55±27 minutes in Group I and Group II respectively. No significant difference was found between the groups in terms of cross-clamp time (p>0.05). The mean time to extubation was 6.1±2.3 hours in Group I and 10.6±3.4 hours in Group II. Group I extubation time was significantly shorter than Group II. Group I TNF-α levels at Post TNF and Post24h TNF was lower than Group II. These differences are also statistically significant (p<0.05).  Conclusion: There is a strong indication that preoperative steroid treatment reduced the TNF-α level together with shortens duration of postoperative intubation and positively contributes to extubation in ventricular septal defect patients operated in cardiac surgery with cardiopulmonary bypass. (ClinicalTrials.gov Identifier: TCTR20150930001)

Keywords

Airway extubation, cardiopulmonary bypass, congenital heart defect, methylprednisolone, tumor necrosis factor-α

References

• 1. Pasquali SK, Hall M, Li JS, Peterson ED, Jaggers J, Lodge AJ, et al. Corticosteroids and outcome in children undergoing congenital heart surgery: analysis of the Pediatric Health Information Systems database. Circulation 2010;122:2123-30. [CrossRef]
• 2. Haddad R, El-Hassan D, Araj A, Hallal A, Abdelnoor AM. Some inflammation related parameters in patients following normo and hypothermic cardio-pulmonary bypass. ImmunopharmacolImmunotoxicol. 2001;23:291-302. [CrossRef]
• 3. Annane D, Bellissant E, Cavaillon JM. Septic shock. Lancet 2005;365:63-78. [CrossRef]
• 4. Kats S, Schönberger JP, Brands R, Seinen W, van Oeveren W. Endotoxin release in cardiac surgery with cardiopulmonary bypass: pathophysiology and possible therapeutic strategies. Eur J Cardiothorac Surg 2011;39:451-8. [CrossRef]
• 5. Bronicki RA, Backer CL, Baden HP, Mavroudis C, Crawford SE, Green TP. Dexamethasone reduces the inflammatory response to cardiopulmonary bypass in children. Ann Thorac Surg 2000;69:1490-5. [CrossRef]
• 6. Soltani G, Abbasi Tashnizi M, Moeinipour AA, Ganjifard M, Esfahanizadeh J, Sepehri Shamloo A, et al. Comparing the effect of preoperative administration of methylprednisolone and its administration before and during surgery on the clinical outcome in pediatric open heart surgeries. Iran Red Crescent Med J 2013;15:483-7. [CrossRef]
• 7. Rinder CS, Bonan JL, Rinder HM, Mathew J, Hines R, Smith BR. Cardiopulmonary bypass induces leukocyte-platelet adhesion. Blood 1992;79:1201-5.
• 8. Varan B, Tokel K, Mercan S, Dönmez A, Aslamaci S. Systemic inflammatory response related to cardiopulmonary bypass and its modification by methylprednisolone: high dose versus low dose. Pediatr Cardiol 2002;23:437-41. [CrossRef]
• 9. Steinberg JB, Kapelanski DP, Olson JD, Weiler JM. Cytokine and complement levels in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg 1993;106:1008-16.
• 10. Allan CK, Newburger JW, McGrath E, Elder J, Psoinos C, Laussen PC, et al. The relationship between inflammatory activation and clinical outcome after infant cardiopulmonary bypass. Anesth Analg 2010;111:1244-51. [CrossRef]
• 11. Franke A, Lante W, Fackeldey V, Becker HP, Thode C, Kuhlmann WD, et al. Proinflammatory and anti-inflammatory cytokines after cardiac operation: Different cellular sources at different times. Ann Thorac Surg 2002;74:363-71. [CrossRef]
• 12. Noronha IL, Niemir Z, Stein H, Waldher R. Cytokines and growth factors in renal disease. Nephrol Dial Transplant 1995;10:775-86.
• 13. Randolph AG, Wypij D, Venkataraman ST, Hanson JH, Gedeit RG, Meert KL, et al. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial. JAMA 2002;288:2561-8. [CrossRef]
• 14. Wan S, LeClerc JL, Vincent JL. Cytokine responses to cardiopulmonary bypass: lessons learned from cardiac transplantation. Ann Thorac Surg 1997;63:269-76. [CrossRef]
• 15. Bourbon A, Vionnet M, Leprince P, Vaissier E, Copeland J, McDonagh P, et al. The effect of methylprednisolone treatment on the cardiopulmonary bypass-induced systemic inflammatory response. Eur J Cardiothorac Surg 2004;26:932-8. [CrossRef]
• 16. Graham EM, Atz AM, Butts RJ, Baker NL, Zyblewski SC, Deardorff RL, et al. Standardized preoperative corticosteroid treatment in neonates undergoing cardiac surgery: results from a randomized trial. J Thorac Cardiovasc Surg 2011;142:1523-9. [CrossRef]
• 17. Casey LC. Role of cytokines in the pathogenesis of cardiopulmonary induced multisystem organ failure. Ann Thorac Surg 1993;56:S92-S6. [CrossRef]
• 18. Clarizia NA, Manlhiot C, Schwartz SM, Sivarajan VB, Maratta R, Holtby HM, et al. Improved outcomes associated with intraoperative steroid use in high-risk pediatric cardiac surgery. Ann Thorac Surg 2011;91:1222-7. [CrossRef]
• 19. Tennenberg SD, Bailey WW, Cotta LA, Brodt JK, Solomkin JS. The effects of methylprednisolone on complement-mediated neutrophil activation during cardiopulmonary bypass. Surgery 1986;100:134-41.
• 20. Ohkawa F, Ikeda U, Kanbe T, Kawasaki K, Shimada K. Effects of inflammatory cytokines on vascular tone. Cardiovasc Res 1995;30:711-5. [CrossRef]
• 21. Ito H, Hamano K, Gohra H, Katoh T, Fujimura Y, Tsuboi H, et al. Relationship between respiratory distress and cytokine response after cardiopulmonary bypass. Surg Today 1997;27:220- 5. [CrossRef]
• 22. Ritter LS, Copeland JG, McDonagh PF. Fucoidin reduces coronary microvascular leukocyte accumulation early in reperfusion. Ann Thorac Surg 1998;66:2063-72. [CrossRef]
• 23. Boelke E, Storck M, Buttenschoen K, Berger D, Hannekum A. Endotoxemia and mediator release during cardiac surgery. Angiology 2000;51:743-9. [CrossRef]
• 24. Zupancich E, Paparella D, Turani F, Munch C, Rossi A, Massaccesi S, et al. Mechanical ventilation affects inflammatory mediators in patients undergoing cardiopulmonary bypass for cardiac surgery: a randomized clinical trial. J Thorac Cardiovasc Surg 2005;130:378-83. [CrossRef]
• 25. Akhtar MI, Hamid M, Minai F, Wali AR, Anwar-ul-Haq, AmanUllah M, et al. Safety profile of fast-track extubation in pediatric congenital heart disease surgery patients in a tertiary care hospital of a devoloping country: An observational prospective study. J Anaesthesiol Clin Pharmacol 2014;30:355-9. [CrossRef]