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HERDIN Record #: PCHRD072009060753 Submitted: 21 July 2009

Randomized control trial on the efficacy of additional pretreatment with methylprednisolone in preventing cerebrovascular injury among children undergoing cardiopulmonary bypass .

Aurora S. Gamponia,
Ma Lourdes S. Casas,
Virginia C. Mappala,
Magdalena J. Lagamayo

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Objective ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Cardiopulmonary bypass causes major neurologic sequelae among neonates and children. Steroid administration during cardiopulmonary bypass is thought to increase anti-inflammatory response. This study was designed to determine efficacy of additional methylprednisolone pretreatment in preventing cerebrovascular injury among children undergoing cardiopulmonary bypass.

Methods ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Sixty patients undergoing cardiopulmonary bypass procedures were randomly assigned to receive additional preoperative and intraoperative methylprednisolone (30mg/kg 6 hours before bypass and in bypass prime, n=30) or intraoperative (pump prime methylprednisolone alone (30mg/kg, n=30). Patients were monitored for development of any neurologic problems immediately after bypass, thereafter until the 72 hours. If a patient would develop any neurologic problems at anytime, an EEC, cranial ultrasound and/or CT scan, and Fundoscopy will be done in all patients. Compared with intraoperative MP alone, among the 25 patients who received additional MP preoperatively, only 1 patient (3 percent) developed cerebrovascular injury after CPB (p<0.05). Patients who received additional MP also had shorter mechanical ventilator support and shorter length of RR, PICU, and hospital stay. Compared with pump prime steroid alone, patients who received additional MP also had less post-operative complications.

Conclusion ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Additional Methylprednisolone pretreatment is effective in preventing cerebral injury among patients undergoing cardiopulmonary bypass as well as in decreasing postoperative complications.

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Quarterly
Publication Date
January-March 2007
Volume
13
Issue
1
Page(s)
12-16

Objectives

To determine the efficacy of additional methylprednisolone pretreatment in the prevention of cerebrovascular injury among children undergoing cardiopulmonary bypass and open heart surgery.

Specific Objectives:

1. To compare the incidence of neurologic signs and symptoms in the experimental and control group as to the presence of:

A. Neonates & infants (< 1 year old)
1. seizure
1.1 focal
1.2 generalized
2. bulging fontanel (sign of increase intracranial pressure)
3. pupils
4. other neurologic sequelae

B. children & adolescent
1. seizure
a. focal
b. generalized 1 pupillary reaction 3. other neurologic sequelae
2. To correlate the neurologic signs and symptoms as to objective
findings:
a. fundoscopy
b. Eletroencephalogram
c. Cranial ultrasound and/or CT scan

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Philippine Council for Health Research and Development Library Abstract Print Format (Request Document)