Top

Published in:

01-12-2016 | Original Article

Preoperative High Dose of Methylprednisolone Improves Early Postoperative Pulmonary Function, in Super-Obese Patients Undergoing Open Surgery; a Prospective, Comparative Study

Authors: George Skroubis, George Theofanis, Charalampos Spyropoulos, Anastasia Zotou, Petros Constantinopoulos, Fotis Kalfarentzos, Theodore Alexandrides

Published in: Journal of Gastrointestinal Surgery | Issue 12/2016

Abstract

Background

Surgery stimulates an intense systemic inflammatory response which might increase postoperative morbidity. Corticosteroids may reduce this inflammatory reaction. The purpose of this study was to investigate any possible effect on postoperative morbidity and recovery after administrating methylprednisolone in super-obese patients undergoing open surgery.

Methods

Sixty super-obese patients with BMI ≥50 kg/m² (mean 57.48 ± 7.33), mean age of 39 ± 9 years, who underwent an open bariatric procedure, were enrolled. Thirty patients (group A) were allocated to a preoperative single dose of 30 mg/kg (ideal body weight) methylprednisolone versus placebo (group B, 30 patients). Endpoints included assessment of IL-6 and CRP; evaluation of postoperative pulmonary function, pain management, nausea, and vomiting; and documentation of postoperative complications.

Results

Significant improvement in spirometry parameters and arterial blood gas analysis, in the first and third postoperative days, was observed in the methylprednisolone group. IL-6 and CRP levels were significantly lower in that group. Administration of methylprednisolone was associated with less postoperative pain, nausea, and vomiting, with no statistical difference in septic complications.

Conclusions

Preoperative administration of a single high dose of methylprednisolone in super-obese patients undergoing open surgery inhibits the inflammatory signaling cascade, lessens the systemic inflammatory response, and results in fewer pulmonary complications and better patient recovery.

Wilmore DW. Metabolic response to severe surgical illness: overview. World J Surg 2000; 24: 705–11CrossRefPubMed

Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85: 109–17CrossRefPubMed

Gabay C, Kushner I. Acute phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340: 448–54CrossRefPubMed

Johnson JL, Moore EE, Tamura DY, Zallen G, Biffl WL, Silliman CC. Interleukin-6 augments neutrophil cytotoxic potential via selective enhancement of elastase release. J Surg Res 1998; 76: 91–4CrossRefPubMed

Oka Y, Murata A, Nishijima J, Yasuda T, Hiraoka N, Ohmachi Y, Kitagawa K, Yasuda T, Toda H, Tanaka N. Circulating interleukin 6 as a useful marker for predicting postoperative complications. Cytokine 1992; 4: 298 – 304CrossRefPubMed

Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 2002; 195: 694–712CrossRefPubMed

Srinivasa S, Kahokehr AA, Yu TC, Hill AG. Preoperative glucocorticoid use in major abdominal surgery: systematic review and meta-analysis of randomized trials. Ann Surg 2011; 254: 183–191CrossRefPubMed

Engelman E, Maeyens C. Effect of preoperative single-dose corticosteroid administration on postoperative morbidity following esophagectomy. J Gastrointest Surg 2010; 14: 788–804CrossRefPubMed

Barber AE, Coyle SM, Fischer E, Smith C, van der Poll T, Shires GT, Lowry SF. Influence of hypercortisolemia on soluble tumor necrosis factor receptor II and interleukin-1 receptor antagonist responses to endotoxin in human beings. Surgery 1995; 118: 406–10CrossRefPubMed

10.

Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003; 362: 1921–8CrossRefPubMed

11.

Barnes PJ. Anti-inflammatory actions of glucocorticoids: molecular mechanisms. Clin Sci (Lond) 1998; 94: 557–72CrossRef

12.

La Vignera S, Condorelli R, Bellanca S, La Rosa B, Mousaví A, Busa B, Vicari LO, Vicari E. Obesity is associated with a higher level of pro-inflammatory cytokines in follicular fluid of women undergoing medically assisted procreation (PMA) programs. Eur Rev Med Pharmacol Sci 2011; 15: 267–73PubMed

13.

Chung MY, Hong SJ, Lee JY. The influence of obesity on postoperative inflammatory cytokine levels. J Int Med Res 2011; 39: 2370–8CrossRefPubMed

14.

Anty R, Bekri S, Luciani N, Saint-Paul MC, Dahman M, Iannelli A, Amor IB, Staccini-Myx A, Huet PM, Gugenheim J, Sadoul JL, Le Marchand-Brustel Y, Tran A, Gual P. The inflammatory C-reactive protein is increased in both liver and adipose tissue in severely obese patients independently from metabolic syndrome, Type 2 diabetes, and NASH. Am J Gastroenterol 2006; 101: 1824–33CrossRefPubMed

15.

Aleman JO, Eusebi LH, Ricciardiello L, Patidar K, Sanyal AJ, Holt PR. Mechanism of obesity-induced gastrointestinal neoplasia. Gastroenterology 2014; 146: 357–73CrossRefPubMed

16.

Kalfarentzos F, Skroubis G, Karamanakos S, Argentou M, Mead N, Kehagias I, Alexandrides TK. Biliopancreatic diversion with Roux-en-Y gastric bypass and long limbs: advances in surgical treatment for super-obesity. Obes Surg 2011; 21: 1849–58CrossRefPubMed

17.

Bloomston M, Zervos EE, Camps MA, Goode SE, Rosemurgy AS. Outcome following bariatric surgery in super versus morbidly obese patients: does weight matter? Obes Surg 1997; 7: 414–9CrossRefPubMed

18.

DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis 2007; 3: 134–140CrossRefPubMed

19.

Demaria EJ, Murr M, Byrne TK, Blackstone R, Grant JP, Budak A, Wolfe L. Validation of the obesity surgery mortality risk score in a Multicenter Study Proves it Stratifies Gastric Bypass for Morbid Obesity. Ann Surg 2007; 246: 578–584CrossRefPubMed

20.

Balistreri CR, Caruso C, Candore G. The role of adipose tissue and adipokines in obesity-related inflammatory diseases. Mediators Inflamm 2010; 2010: 802078CrossRefPubMedPubMedCentral

21.

Zotti GC, Salzano de Luna F, Caiazza A, Santaniello W, Micheletti G, Bruno A, Casadei CL. Prevention of pulmonary complications by 6-methylprednizolone in major abdominal surgery. Ital J Surg Sci 1988; 18: 369–375PubMed

22.

Fecht DC, Magovern GJ, Park SB, Merkow LP, Dixon CM, Dosios T, Pardo M. Beneficial effects of methylprednisolone in patients on cardiopulmonary bypass. Circ Shock 1978; 5: 415–422PubMed

23.

Pelosi P, Gregoretti C. Perioperative management of obese patients. Best Prac Res Clin Anaesth 2010; 24: 211–25CrossRef

24.

Hennein HA, Ebba H, Rodriguez JL, Merrick SH, Keith FM, Bronstein MH, Leung JM, Mangano DT, Greenfield LJ, Rankin JS. Relationship of the proinflammatory cytokines to myocardial ischemia and dysfunction after uncomplicated coronary revascularization. J Thorac Cardiovasc Surg 1994; 108: 626–35PubMed

25.

Deng MC, Dash B, Erren M, Mollhoff T, Scheld HH. Impact of left ventricular dysfunction on cytokines, hemodynamics and outcome in by-pass grafting. Ann Thorac Surg 1996; 62: 184–190CrossRefPubMed

26.

Moussa AA, Oregan PJ. Prevention of postoperative nausea and vomiting in patient undergoing laparoscopic bariatric surgery - granisetron alone vs granisetron combined with dexamethasone/droperidol. Middle East J Anaesthesiol 2007; 19: 357 – 367PubMed

27.

Mendes MN, Monteiro Rde S, Martins FA. Prophylaxis of postoperative nausea and vomiting in morbidly obese patients undergoing laparoscopic gastroplasties: a comparative study among three methods. Rev Bras Anestesiol 2009; 59: 570–6PubMed

28.

Karanicolas PJ, Smith SE, Kanbur B, Davies E, Guyatt GH. The impact of prophylactic dexamethasone on nausea and vomiting after laparoscopic cholecystectomy: a systematic review and meta-analysis. Ann Surg 2008; 248: 751–62CrossRefPubMed

29.

Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systemic review. Anesth Analg 2000; 90: 186–194CrossRefPubMed

30.

Hargreaves KM, Costello A. Glucocorticoids levels of immunoreactive bradykinin in inflamed tissue as evaluated by microdialysis probes. Clin Pharmacol Ther 1990; 48: 168–178CrossRefPubMed

31.

Feld JM, Hoffman WE, Stechert MM, Hoffman IW, Ananda RC. Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery. J Clin Anest 2006; 18: 24–8CrossRef

32.

Yared JP, Starr NJ, Torres FK, Bashour CA, Bourdakos G, Piedmonte M, Michener JA, Davis JA, Rosenberger TE. Effects of single dose, postinduction dexametathasone on recovery after cardiac surgery. Ann Thorac Surg 2000; 69: 1420–73CrossRefPubMed

Title: Preoperative High Dose of Methylprednisolone Improves Early Postoperative Pulmonary Function, in Super-Obese Patients Undergoing Open Surgery; a Prospective, Comparative Study
Authors: George Skroubis
George Theofanis
Charalampos Spyropoulos
Anastasia Zotou
Petros Constantinopoulos
Fotis Kalfarentzos
Theodore Alexandrides
Publication date: 01-12-2016
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 12/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-016-3281-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Preoperative High Dose of Methylprednisolone Improves Early Postoperative Pulmonary Function, in Super-Obese Patients Undergoing Open Surgery; a Prospective, Comparative Study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2016

Prognostic Value of Lymph Node Status and Extent of Lymphadenectomy in Pancreatic Neuroendocrine Tumors Confined To and Extending Beyond the Pancreas

Randomized Comparison of Subcuticular Sutures Versus Staples for Skin Closure After Open Abdominal Surgery: a Multicenter Open-Label Randomized Controlled Trial

Transarterial Chemoembolization for the Treatment of Advanced-Stage Hepatocellular Carcinoma

Reply: Hepatic Hemodynamic Changes Following Stepwise Liver Resection (Golriz et al. J Gastrointest Surg (2016) 20:587-594)

Impact of Delta Hemoglobin on Provider Transfusion Practices and Post-operative Morbidity Among Patients Undergoing Liver and Pancreatic Surgery

Mucosal Perforation During Laparoscopic Heller Myotomy Has No Influence on Final Treatment Outcome