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J Thorac Cardiovasc Surg 1999;117:1004-1008
© 1999 Mosby, Inc.
CARDIOPULMONARY SUPPORT AND PHYSIOLOGY |
From the Division of Cardiothoracic Surgery,a Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China, and Departments of Cardiac Surgery,b Anesthesiology,c and Intensive Care,d University Hospital Erasme, Free University of Brussels, Brussels, Belgium.
This study was supported by Fondation pour la Chirurgie Cardiaque, Belgium.
Received for publication June 11, 1998. Revisions requested Oct 30, 1998. Revisions received Jan 21, 1999. Accepted for publication Jan 21, 1999. Address for reprints: Song Wan, MD, PhD, Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
Objective: The mechanism involved in the endotoxemia frequently recognized during cardiopulmonary bypass remains unclear. It has also been suggested that endotoxin levels were higher in steroid-pretreated patients undergoing cardiopulmonary bypass.
Methods: Twenty patients undergoing cardiopulmonary bypass were randomly pretreated with steroids (methylprednisolone, 30 mg/kg) or placebo. Blood samples for endotoxin measurement were drawn simultaneously from the superior and inferior venae cavae before heparin administration, 5 and 50 minutes after the onset of bypass, 5 minutes after aortic declamping, at the end of bypass, and 1, 2, and 20 hours after the end of cardiopulmonary bypass.
Results: The perioperative variables in the two groups were similar. Blood endotoxin levels were higher in the inferior vena cava than in the superior vena cava immediately after the onset of bypass. Endotoxin levels in inferior vena cava blood were significantly lower in steroid-pretreated patients than those in patients not receiving steroids.
Conclusions: Endotoxin is released during cardiopulmonary bypass from the region drained by the inferior vena cava. Steroid pretreatment may actually reduce endotoxin release during bypass.
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