Methylprednisolone in neonates following cardiac surgery ~ Potent rapid vasopressor ?

  • Kazuyoshi Shimizu, Dept. of Anesthesiology and Resuscitology, Okayama University Medical School, Japan
  • Hiroshi Morimatsu, Dept. of Anesthesiology and Resuscitology, Okayama University Medical School, Japan
  • Yuichiro Toda, Dept. of Anesthesiology and Resuscitology, Okayama University Medical School, Japan
  • Satoshi Suzuki, Dept. of Anesthesiology and Resuscitology, Okayama University Medical School, Japan
  • Tomohiko Suemori, Dept. of Anesthesiology and Resuscitology, Okayama University Medical School, Japan
  • Tatsuo Iwasaki, Dept. of Anesthesiology and Resuscitology, Okayama University Medical School, Japan
  • Kiyoshi Morita, Dept. of Anesthesiology and Resuscitology, Okayama University Medical School, Japan

    • Background
    We have investigated retrospectively the global hemodynamic effects of methylprednisolone (MP) in 3 hours after administration in the neonates after cardiac surgery.

    Methods
    A retrospective chart review was conducted for 67 neonates with congenital heart disease, who underwent cardiac surgery from 2004 to 2005 at Okayama University Hospital. We collected their demographics, operative variables, ICU admission variables, and outcomes. They were divided into two groups, steroid (S) group and non-steroid (NS) group, whether received steroid treatment in the ICU period. Comparisons have been done between the groups using Student’s t-test. Among S group, we also assessed 5 global hemodynamic changes including the dose of epinephrine, mean arterial pressure (MAP), base excess (BE), lactate concentration (Lac), and urine output (UO) between pre-3 hours and post-3 hours of steroid administration. Data were expressed as mean with 95% confidence interval, and a p value < 0.05 was considered as statistically significant.

    Results
    Of 67 neonates, 40 (57.1%) received MP with a mean dose of 10.0mg/kg (8.3, 11.7). The S group received more complex operation. On ICU admission, the S group was severer than the NS group, although their ICU survival did not differ. Three hours after the administration of MP, MAP was significantly increased, however, BE, Lac, and UO did not improve significantly (Table).

    Conclusion
    Steroid was administered in neonates who received more complex surgery, and who were hypotensive. The effect of methylprednisolone has already occurred within 3 hours after administration as “vasopressor” rather than “inotrope”.

    Pre steroid Post steroid P value
    Epinephrine dose (mcg/kg/min) 0.05 (0.03,0.07) 0.056 (0.036,0.075) 0.23
    MAP (mmHg) 52.7 (49.9,55.5) 56.7 (53.8,59.6) 0.001
    Base excess (mmol/L) 0.2 (-1.3,1.6) -0.3 (-1.6,1.1) 0.24
    Lactate (mmol/L) 3.8 (2.7,5.0) 4.4 (2.6,6.2) 0.35
    Urine output (ml/kg/h) 3.3 (2.5,4.2) 3.9 (2.8,5.0) 0.31