Con: Methylprednisolone is not indicated for patients during cardiopulmonary bypass

Abstract

THE USE OF STEROIDS in the setting of cardiac surgery utilizing cardiopulmonary bypass (CPB) has been a topic of debate for several decades. 1 Moses M.L. Camishion R.C. Tokunaga K. et al. Effect of corticosteroid on the acidosis of prolonged cardiopulmonary bypass. J Surg Res. 1966; 6: 354-360 Abstract Full Text PDF PubMed Scopus (12) Google Scholar , 2 Dietzman R.H. Lunseth J.B. Goott B. et al. The use of methylprednisolone during cardiopulmonary bypass A review of 427 cases. J Thorac Cardiovasc Surg. 1975; 69: 870-873 PubMed Google Scholar , 3 Toledo-Pereyra L.H. Lin C.Y. Kundler H. et al. Steroids in heart surgery A clinical double-blind and randomized study. Am Surg. 1980; 46: 155-160 PubMed Google Scholar , 4 Chaney M.A. Corticosteroids and cardiopulmonary bypass A review of clinical investigations. Chest. 2002; 121: 921-931 Crossref PubMed Scopus (152) Google Scholar The current perioperative utilization of steroids varies as much among practitioners as do their purported indications; whereas some centers use steroids routinely for cardiac surgery, others have steadfastly avoided their use. The argument opposing the routine use of steroids is largely based on two major premises: (1) there is an overall paucity of data supporting any beneficial effects of this class of drug in cardiac surgery, and (2) the tenet in medicine “of first doing no harm,” indicating that when studies show limited benefit coupled with some detriment to a specific therapy, it should not be used. Put another way, making the argument against the routine use of steroids becomes relatively easy as there are no convincing data (ie, randomized, double-blind, placebo-controlled trials) outlining any significant benefits to steroids in cardiac surgery patients and there is data indicating that there may be some harm associated with their use.