The effect of preoperative high dose methylprednisolone in attenuating the metabolic response after oesophageal resection

Abstract

Objective: To evaluate the effect of giving glucocorticoids preoperatively for the prophylaxis of surgical stress.

Design: Prospective randomised study.

Setting: University hospital, Japan.

Subjects: 30 patients undergoing resection of oesophageal carcinoma.

Interventions: 15 patients (group 1) were randomised to be given methylprednisolone (30 mg/kg) and 15 patients (group 2) to be given saline intravenously before operation.

Main outcome measures: Outcome, length of stay in the intensive care unit (ICU), metabolic response, and oxygenation.

Results: Patients given methylprednisolone had a mean stay in the ICU of 5.1 +/- 1.0 days compared with 8.2 +/- 4.5 days in the saline group (p < 0.01). 5 patients in the saline group compared with 0 in the methylprednisolone group developed postoperative complications (p = 0.02). Plasma norepinephrine and arginine vasopressin levels in methylprednisolone group were significantly lower than those in the saline group (p < 0.05). The PaO2:FiO2 ratio in the saline group was significantly lower than that in the experimental group (p < 0.01).

Conclusions: Preoperative methylprednisolone may facilitate the postoperative management of surgical patients.