The Effects Of Methylprednisolone In Reducing Myocardial Injury During Cardiopulmonary Bypass

Objective:Ischemic reperfusion injury, systemic inflammatory response and multi-organdysfunction are not infrequent following Cardiopulmonary Bypass (cpb).we investigated therole of methylprednisolone in minimizing myocardial and renal injury.Subjects and Methods:34heart disease patients undergoing elective heart surgeries having aeuro score of≥4and using cardiopulmonary bypass machine were assessed,enrolled andrandomly allocated to two groups,the placebo group p (n=17,were given4ml of normalsaline at induction of anesthesia and another4ml of normal saline prior to start of cpb)andthe methyl prednisolone group m(n=17,were given4ml i.e.250mg of methyl prednisoloneat induction of anesthesia and another i.e.250mg of methylprednisolone prior to start ofcpb).CKMB levels and plasma creatinine values were used as indicators of myocardium n renal injury respectively. Blood samples for CKMB were collected at3different intervals(T1-before induction of anesthesia,T2-8hours post-surgery and T3-24hours post-surgery)whereas the plasma creatinine were noted pre-surgery and the peak creatinine value duringthe hospital stay were noted as well other parameters such as duration of mechanicalventilation,blood transfusion,chest drains, length of icu and hospital stay, peak random bloodsugar,cpb time were also recorded.ResultsCompared to baseline levels at T1the serum levels of CKMB both in the m and p groupincreased from T1to T2that is8hours post-surgery and then decreased at time T3that is24hours post-surgery. However the levels of CKMB were lesser in the m group at both timepoints T2and T3.The data were analysed separately at different time intervals usingindependent t test. The CKMB levels at time interval T2and T3were compared using pairedt-test. The overall effects of methylprednisolone on both groups were compared using anova.The p values (0.6947and0.0555, i.e p>0.05) at separate point time intervals at0hour and8hours shows that there were no statistically significant differences between them. Howeverinterestingly at the24hour (p=0.0012i.e. p<0.05) showed that the results were statisticallysignificant.The group effect comparison and the overall effect of methylprednisolone onCKMB levels were both significant (p=0.0002and0.0274i.e. p<0.05The rise in serum creatinine postoperatively did not have any statisticalsignificance(P>0.05).The average increase was around23%in the methylpredinisolone groupcompared to28%in the placebo group.The chest drain24hours post operatively was less in the M group compared to the P group(429.12±127.65and588.76±153.30) respectively and the amount of packed cells transfusedwas consequently lesser in the M group (423.53±113.35and541.18±132.57). However theresults were not significant. ConclusionThe use of250mg of methyl prednisolone at induction and another250mg prior to initiationof cpb is associated with a decrease in myocardial injury postoperatively and a more stablepost-operative course with lesser blood loss and blood transfusion.