Preoperative high dose methylprednisolone attenuates the cerebral response to deep hypothermic circulatory arrest

Stephen M. Langley, Paul J. Chai, James J. Jaggers, Ross M. Ungerleider

    Research output: Contribution to journalArticle

    67 Scopus citations

    Abstract

    Objective: The aim of this study was to assess the effects of preoperative high dose methylprednisolone on cerebral recovery following a period of deep hypothermic circulatory arrest (DHCA). Methods: Sixteen 1-week-old piglets were randomized to placebo (n=8), or 30 mg/kg intramuscular methylprednisolone sodium succinate (MPRED) given at 8 and 2 h before induction of anaesthesia. All piglets underwent cardiopulmonary bypass, cooling to 18°C, 60 min of circulatory arrest followed by 60 min of reperfusion and rewarming. The radiolabelled microsphere method was used to determine the global and regional cerebral blood flow (CBF) and cerebral oxygen metabolism (CMRO2) at baseline before DHCA and after 60 min of reperfusion. Results: In controls, mean global CBF (±1 standard error) before DHCA was 53.7±2.4 ml/100 g per min and fell to 23.8±1.2 ml/100 g per min following DHCA (P<0.0001). This represents a post-DHCA recovery to 45.1±3.3% of the pre-DHCA value. In the MPRED group recovery of global CBF post-DHCA was significantly higher at 63.6±5.2% of the pre-DHCA value (P=0.009). The regional recovery of CBF in the cerebellum, brainstem and basal ganglia was 80, 75 and 69% of pre-DHCA values in the MPRED group respectively compared to 66, 60 and 55% in controls (P<0.05). Global CMRO2 in controls fell from 3.9±0.2 ml/100 g per min before to 2.3±0.2 ml/100 g per min after DHCA (P=0.0001). This represents a post-DHCA recovery to 58.6±4.4% of the pre-DHCA value. In the MPRED group, however, recovery of global CMRO2 post-DHCA was significantly higher at 77.9±7.1% of the pre-DHCA value (P=0.04). Conclusions: Treatment with high dose methylprednisolone at 8 and 2 h preoperatively attenuates the normal cerebral response to a period of deep hypothermic ischaemia. This technique may therefore offer a safe and inexpensive strategy for cerebral protection during repair of congenital heart defects with the use of DHCA. Copyright (C) 2000 Elsevier Science B.V.

    Original languageEnglish (US)
    Pages (from-to)279-286
    Number of pages8
    JournalEuropean Journal of Cardio-Thoracic Surgery
    Volume17
    Issue number3
    DOIs
    StatePublished - Mar 1 2000

    Keywords

    • Circulatory arrest
    • Congenital heart defects
    • Methylprednisolone

    ASJC Scopus subject areas

    • Surgery
    • Pulmonary and Respiratory Medicine
    • Cardiology and Cardiovascular Medicine

    Fingerprint Dive into the research topics of 'Preoperative high dose methylprednisolone attenuates the cerebral response to deep hypothermic circulatory arrest'. Together they form a unique fingerprint.

  • Cite this