Effects of Dexamethasone on Pulmonary and Renal Functions in Patients Undergoing CABG With Cardiopulmonary Bypass

Author:

Yasser Mohamed Amr 1,Elmistekawy Elsayed2,El-serogy Hesham2

Affiliation:

1. Tanta University, Tanta, Egypt,

2. Tanta University, Tanta, Egypt

Abstract

This study evaluates whether dexamesathone in patients undergoing CABG using CPB results in better renal and pulmonary outcome. Methods: 100 patients were randomized to receive either placebo or dexamethasone (1 mg/ kg, at induction of anesthesia and 0.5 mg/kg 8 h later). Results: The differences regarding pulmonary parameters over times were significant in relation to measurements taken 10 minutes after intubation within groups; nevertheless, differences were significant between groups only at 12, 24 hours for A-a O2 gradient, respiratory index, PaO2/FiO2 ratio. Dexamethasone had no effect on extubation time. Creatinine clearance, urinary micro albumin excretion and (NAG) levels were comparable in both the groups. The dexamethasone treated patients were more likely to have hyperglycemia. Conclusions: Dexamethasone offers no renal protective effect and the drug is associated with significant improvement in A-a O2 gradient, respiratory index, PaO2/FiO 2 at 12, 24 hours postoperatively and had no effect on extubation time and lung compliance.

Publisher

SAGE Publications

Subject

Anesthesiology and Pain Medicine,Cardiology and Cardiovascular Medicine

Reference16 articles.

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3. Endothelial Cell Injury in Cardiovascular Surgery: The Systemic Inflammatory Response11Recent discoveries in the field of vascular biology have led to an expanded understanding of the pathogenesis of many of the immediate and long-term complications of patients undergoing cardiovascular operations and interventional cardiologic procedures. In particular, the vascular endothelium has emerged as the central focus of many of the biologic events that affect the preoperative, operative, and postoperative course of nearly all heart surgery patients. A recurring theme in the study of endothelial cell biology is the crucial role that endothelial cell injury plays in the difficulties that our patients encounter. The deleterious effects of endothelial cell injury are most evident in the acute syndromes of vasospasm, coagulopathy, ischemia/reperfusion injury, and the systemic inflammatory response to cardiopulmonary bypass. In addition, chronic endothelial cell injury contributes to the development of anastomotic narrowing and the progression of atherosclerosis, both of which limit the long-term success of coronary artery bypass grafting. Because of the increasingly recognized role of the endothelium in cardiovascular function there is a tremendous amount of basic science information detailing the response of the endothelium to injury. This is the fifth in a series of seven reviews intended as an introduction to the major topics of endothelial cell biology that are of importance to the practicing cardiothoracic surgeon. In particular, the authors have focused on the role that the endothelium has on the development of vasomotor dysfunction, bleeding and thrombosis, neutrophil-endothelial cell interaction, and obstructive arteriopathy. The aim of these reviews is to provide a concise reference point for cardiothoracic surgeons as they evaluate the ever-accumulating research findings and new therapies that stem from the study of the endothelium in response to the insults encountered in cardiothoracic surgery.Edward D. Verrier, MD

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