Dexamethasone reduces postoperative troponin levels in children undergoing cardiopulmonary bypass*

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Abstract

Objective

We previously demonstrated that dexamethasone treatment before cardiopulmonary bypass in children reduces the postoperative systemic inflammatory response. The purpose of this study was to test the hypothesis that dexamethasone administration before cardiopulmonary bypass in children correlates with a lesser degree of myocardial injury as measured by a decrease in cardiac troponin I release.

Design

A prospective, randomized, double-blind study.

Setting

The cardiac surgery operating room and intensive care unit of a pediatric referral hospital.

Subjects

Twenty-eight patients who underwent open-heart surgery for congenital heart defects.

Interventions

Patients received either placebo (group I, n = 13) or dexamethasone, 1 mg/kg iv (group II, n = 15), 1 hr before initiation of cardiopulmonary bypass. Plasma cardiac troponin I samples were obtained at three time points: immediately before study agent (sample 1), 10 mins after protamine sulfate administration after cardiopulmonary bypass (sample 2), and 24 hrs postoperatively (sample 3).

Measurements and Main Results

Mean cardiac troponin I levels (±sd) were significantly lower at sample time 3 in group II (dexamethasone; 33.4 ± 20.0 ng/mL) vs. group I (control; 86.9 ± 81.1) (p = .04).

Conclusion

Dexamethasone administration before cardiopulmonary bypass in children resulted in a significant decrease in cardiac troponin I levels at 24 hrs postoperatively. We postulate that this may represent a decrease in myocardial injury, and, thus, a possible cardioprotective effect produced by dexamethasone.

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