Preoperative methylprednisolone (15 mg/kg) or tirilazad mesylate (10 mg/kg) reduced lipid peroxidation but did not significantly reduce early arrhythmias compared to placebo in 36 patients.
RCT (n=36)
blinded
randomized
Do preoperative infusions of methylprednisolone or tirilazad mesylate reduce reperfusion-associated reactive oxygen species production and arrhythmias in patients undergoing coronary surgery?
Preoperative steroid treatment reduces lipid peroxidation but does not prevent reperfusion-associated arrhythmias during coronary surgery.
Background: During conventional cardiac surgery ischemia and reperfusion may cause excessive production of reactive oxygen species leading to tissue damage including early arrhythmias. We therefore assessed the kinetics of markers of radical stress including oxidized and reduced glutathione (GSSG/GSH), oxidized proteins (PCG) and malondialdehyde (MDA), and tested the hypothesis that different steroid treatments inhibit these markers and early reperfusion‐associated supraventricular and ventricular extrasystolic beats. Methods: In a randomized, controlled, blinded, prospective trial 36 patients received a preoperative infusion of methylprednisolone (MP, 15 mg kg −1 , n = 12), tirilazad mesylate (TM, 10 mg kg −1 , n = 12) or placebo (PL, NaCl, n = 12). Coronary sinus and arterial blood was drawn at baseline and 2, 5, 15, 30, 60 and 240 min after aortic declamping. Holter‐ECG analysis was used to identify arrhythmias. Results: Cardiac GSSG release occurred very early ( 4 h and was significantly reduced only by TM. Cardiac MDA release was short ( < 30 min) and significantly reduced by MP and TM. Neither treatment had a significant influence on the early occurrence of ventricular or supraventricular arrhythmias. The number of patients needing cardioversions or defibrillations also were not different. Conclusions: The results indicate that cardiac production of reactive oxygen species occurs after reperfusion in humans and is not inhibited by steroid treatment. Steroid treatment effectively reduces lipid peroxidation during cardiac surgery but has no influence on arrhythmias.
Volk et al. (Fri,) conducted a rct in coronary surgery (n=36). Methylprednisolone or tirilazad mesylate vs. Placebo (NaCl) was evaluated on Markers of radical stress (GSSG/GSH, PCG, MDA) and early reperfusion-associated arrhythmias. Preoperative methylprednisolone (15 mg/kg) or tirilazad mesylate (10 mg/kg) reduced lipid peroxidation but did not significantly reduce early arrhythmias compared to placebo in 36 patients.