Journal of Nippon Medical School: Vol.70 No.1 page.016

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ArticleTitle Preoperative Administration of Methylprednisolone Attenuates Cytokine-induced Respiratory Failure After Esophageal Resection

AuthorList Shinhiro Takeda^{1, 2}, Chol Kim¹, Hiroyuki Ikezaki², Kazuhiro Nakanishi², Atsuhiro Sakamoto², Kei-ichi Okawa³, Masao Miyashita³, Koji Sasajima³, Takashi Tajiri³, Keiji Tanaka¹, Ryo Ogawa²

Affiliation ¹Division of Intensive Care Unit and Coronary Care Unit, Nippon Medical School Hospital ²Department of Anesthesiology, Nippon Medical School ³First Department of Surgery, Nippon Medical School

Language EN

Volume 70

Issue 1

Year 2003

Page 16-20

Received June 11, 2002

Accepted August 14, 2002

Keywords glucocorticoid, interleukin-6, interleukin-8, proinflammatory cytokines, surgical stress

Abstract
Proinflammatory cytokines have been implicated in mediating respiratory failure associated with major surgery. We investigated the effect of giving glucocorticoids preoperatively for the prophylaxis of surgical stress and the association of cytokine levels, such as interleukin-6 (IL-6) and interleukin-8 (IL-8), with oxygenation after esophagectomy. We studied 17 patients who underwent subtotal esophagectomy. Seven patients (steroid group) were chosen at random to be given methylprednisolone (10 mg/kg) and 10 patients (control group) to be given saline intravenously before operation. Plasma and bronchoalveolar lavage fluid (BALF) IL-8 levels in the control group were significantly higher than those in the steroid group. In both groups, plasma IL-6 levels were significantly higher than those in BALF, but in contrast, BALF IL-8 levels were significantly higher than plasma levels of IL-8 postoperatively. The PaO₂/FiO₂ ratio was significantly reduced in the control group. The PaO₂/FiO₂ ratio of the control group had significantly lower values than that of the steroid group. There was significant correlation between BALF IL-8 levels and the PaO₂/FiO₂ ratio postoperatively. We conclude that preoperative administration of methylprednisolone may attenuate postoperative reduction of arterial oxygen saturation by suppressing the release of cytokines.

Correspondence to Shinhiro Takeda, MD, PhD, Division of Intensive Care Unit and Coronary Care Unit, Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
shinhiro@nms.ac.jp

ArticleTitle	Preoperative Administration of Methylprednisolone Attenuates Cytokine-induced Respiratory Failure After Esophageal Resection
AuthorList	Shinhiro Takeda^{1, 2}, Chol Kim¹, Hiroyuki Ikezaki², Kazuhiro Nakanishi², Atsuhiro Sakamoto², Kei-ichi Okawa³, Masao Miyashita³, Koji Sasajima³, Takashi Tajiri³, Keiji Tanaka¹, Ryo Ogawa²
Affiliation	¹Division of Intensive Care Unit and Coronary Care Unit, Nippon Medical School Hospital ²Department of Anesthesiology, Nippon Medical School ³First Department of Surgery, Nippon Medical School
Language	EN
Volume	70
Issue	1
Year	2003
Page	16-20
Received	June 11, 2002
Accepted	August 14, 2002
Keywords	glucocorticoid, interleukin-6, interleukin-8, proinflammatory cytokines, surgical stress
Abstract	Proinflammatory cytokines have been implicated in mediating respiratory failure associated with major surgery. We investigated the effect of giving glucocorticoids preoperatively for the prophylaxis of surgical stress and the association of cytokine levels, such as interleukin-6 (IL-6) and interleukin-8 (IL-8), with oxygenation after esophagectomy. We studied 17 patients who underwent subtotal esophagectomy. Seven patients (steroid group) were chosen at random to be given methylprednisolone (10 mg/kg) and 10 patients (control group) to be given saline intravenously before operation. Plasma and bronchoalveolar lavage fluid (BALF) IL-8 levels in the control group were significantly higher than those in the steroid group. In both groups, plasma IL-6 levels were significantly higher than those in BALF, but in contrast, BALF IL-8 levels were significantly higher than plasma levels of IL-8 postoperatively. The PaO₂/FiO₂ ratio was significantly reduced in the control group. The PaO₂/FiO₂ ratio of the control group had significantly lower values than that of the steroid group. There was significant correlation between BALF IL-8 levels and the PaO₂/FiO₂ ratio postoperatively. We conclude that preoperative administration of methylprednisolone may attenuate postoperative reduction of arterial oxygen saturation by suppressing the release of cytokines.
Correspondence to	Shinhiro Takeda, MD, PhD, Division of Intensive Care Unit and Coronary Care Unit, Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan shinhiro@nms.ac.jp