Effect of Dexamethasone on Atrial Fibrillation After Cardiac Surgery: Prospective, Randomized, Double-Blind, Placebo-Controlled Trial

• Published in: Journal of cardiothoracic and vascular anesthesia 2007-02, Vol.21 (1), p.68-75
• Main Authors: Yared, Jean-Pierre, MD, Bakri, Mohamed H., MD, PhD, Erzurum, Serpil C., MD, Moravec, Christine S., PhD, Laskowski, Daniel M., BS, RPFT, Van Wagoner, David R., PhD, Mascha, Edward, PhD, Thornton, Julie, MS
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia & Perioperative Care; atrial fibrillation; Atrial Fibrillation - drug therapy; Atrial Fibrillation - etiology; C-Reactive Protein - analysis; C-Reactive Protein - drug effects; Cardiac Surgical Procedures - methods; cardiopulmonary bypass; Complement C4 - analysis; Complement C4 - drug effects; Coronary Artery Bypass - methods; Critical Care; cytokines; dexamethasone; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Double-Blind Method; Endothelin-1 - blood; Endothelin-1 - drug effects; Female; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Heart Valves - surgery; Humans; Interleukins - blood; Male; Middle Aged; Nitric Oxide - metabolism; Placebos; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Prospective Studies; Sodium Chloride - administration & dosage; Time Factors; Tumor Necrosis Factor-alpha - blood; Tumor Necrosis Factor-alpha - drug effects
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2005.10.014

Objective: The purpose of this study was to assess the effect of preoperative dexamethasone (DEX) on the occurrence of postoperative atrial fibrillation (AF). Design: Prospective, randomized, double-blind, placebo-controlled clinical trial. Setting: Tertiary referral center. Participants: Seventy-eight adult patients undergoing combined valve and coronary artery bypass graft (CABG) surgery were randomized to receive either DEX or placebo. Interventions: The DEX group received dexamethasone, 0.6 mg/kg, after induction of anesthesia, and the placebo group received an equal volume of normal saline. Interleukin (IL)-6, -8, and -10; tumor necrosis factor α; and endothelin (ET)-1 were measured preoperatively and on postoperative days (POD) 1, 2, and 3. Complement (C-4) and C-reactive protein (CRP) were measured preoperatively and on POD 2. Exhaled nitric oxide (NO) was measured preoperatively, 15 minutes after aortic unclamping, and 1 hour after intensive care unit admission. Measurements and Main Results: No significant difference in the incidence of AF was found between the placebo (41%) and DEX groups (30%) (95% confidence interval [−11%, 34%); p = 0.31). DEX significantly reduced at least 1 postoperative level of IL-6, IL-8, IL-10, CRP, and exhaled NO. DEX did not affect ET-1 or C-4 levels. IL-10 on POD 3 was positively correlated with postoperative hospital length of stay ( r = 0.30, p = 0.01). Increased levels of IL-8 and IL-10 on POD 1 were positively correlated with the intubation time ( r = 0.31, p = 0.01; r = 0.30, p = 0.01, respectively). Conversely, C-4 on POD 2 was negatively correlated with the intubation time and intensive care unit length of stay ( r = −0.32, p = 0.006; r = −0.30, p = 0.01, respectively). Conclusions: DEX did not affect the incidence of AF in patients undergoing combined CABG and valve surgery. However, it did modulate the release of several inflammatory and acute-phase response mediators that are associated with adverse outcomes.