Intraoperative Steroid Research Articles

The Effect of Intraoperative Blood Glucose Management on Postoperative Blood Glucose Levels in Noncardiac Surgery Patients.

Postoperative hyperglycemia has been associated with poor surgical outcome. The effect of intraoperative glucose management on postoperative glucose levels and the optimal glycemic threshold for initiating insulin are currently unknown. We performed a retrospective cohort study of surgery patients who required intraoperative glucose management with data extracted from electronic medical records. In patients who required glucose management, intraoperative glucose levels and insulin therapy were compared against postoperative glucose levels during 3 periods: first postoperative level within 1 hour, within the first 12 hours, and 24 hours of the postoperative period. Logistic regression models that adjusted for patient and surgical factors were used to determine the association between intraoperative glucose management and postoperative glucose levels. In 2440 patients who required intraoperative glucose management, an increase in mean intraoperative glucose level by 10 mg/dL was associated with an increase in postoperative glucose levels by 4.7 mg/dL (confidence interval [CI], 4.1-5.3; P < 0.001) for the first postoperative glucose measurement, 2.6 mg/dL (CI, 2.1-3.1; P < 0.001) for the mean first 12-hour postoperative glucose, and 2.4 mg/dL (CI, 2.0-2.9; P < 0.001) for the mean first 24-hour postoperative glucose levels (univariate analysis). Multivariate analysis showed that these effects depended on (interacted with) body mass index and diabetes status of the patient. Both diabetes status (regression coefficient = 12.2; P < 0.001) and intraoperative steroid use (regression coefficient = 10.2; P < 0.001) had a positive effect on elevated postoperative glucose levels. Intraoperative hyperglycemia (>180 mg/dL) was associated with postoperative hyperglycemia during the first 12 hours and the first 24 hours. However, interaction with procedure duration meant that this association was stronger for shorter surgeries. When compared with starting insulin for an intraoperative glucose threshold of 140 mg/dL thus avoiding hyperglycemia, initiation of insulin for a hyperglycemia threshold of 180 mg/dL was associated with an increase in postoperative glucose level (7 mg/dL; P < 0.001) and postoperative hyperglycemia incidence (odds ratio = 1.53; P = 0.01). A higher intraoperative glucose level is associated with a higher postoperative glucose level. Intraoperative hyperglycemia increases the odds for postoperative hyperglycemia. Adequate intraoperative glucose management by initiating insulin infusion when glucose level exceeds 140 mg/dL to prevent hyperglycemia is associated with lower postoperative glucose levels and fewer incidences of postoperative hyperglycemia. However, patient- and procedure-specific variable interactions make the relationship between intraoperative and postoperative glucose levels complicated.

Intraoperative Steroid Use and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network's Public Database.

Data supporting the use of perioperative steroids during cardiac surgery are conflicting, and most pediatric studies have been limited by small sample sizes and/or diverse cardiac diagnoses. The objective of this study was to determine if intraoperative steroid administration improved outcomes following the Norwood procedure. A retrospective analysis was performed on the 549 neonates who underwent a Norwood procedure in the publicly available datasets from the Pediatric Heart Network's Single Ventricle Reconstruction trial. Groups were compared to determine if outcomes differed between intraoperative steroid recipients (n = 498, 91%) and nonrecipients (n = 51, 9%). Fifteen North American centers. Infants enrolled in the Single Ventricle Reconstruction trial. None. Baseline characteristics and intraoperative variables were similar between groups with the exception of a shorter duration of cross clamp and cardiopulmonary bypass time in the group that received steroids. Subjects who did not receive intraoperative steroids had improved hospital survival (94% vs 83%, p = 0.03) but longer ICU stays (16 d; interquartile range, 12-33 vs 14 d; interquartile range, 9-28; p = 0.04) and hospital stays (29 d; interquartile range, 21-50 vs 23 d; interquartile range, 15-40; p = 0.01) than steroid recipients. In multivariate analysis, lengths of stay associations were no longer significant, but hospital survival trended toward favoring the nonsteroid group with an odds ratio of 3.52 (95% CI, 0.98-12.64; p = 0.054). In the large multicentered Single Ventricle Reconstruction trial, there was widespread use of intraoperative steroids. Intraoperative steroid administration was not associated with an improvement in outcomes and may be associated with a reduction in hospital survival in neonates undergoing the Norwood procedure. This study highlights the need for a randomized control trial.

Key perspectives on Woven EndoBridge device for wide-necked bifurcation aneurysms, endoscopic endonasal clipping of intracranial aneurysms, retrosigmoid versus translabyrinthine approaches for acoustic neuromas, and impact of local intraoperative steroid administration on postoperative dysphagia following anterior cervical discectomy and fusion.

Key perspectives on Woven EndoBridge device for wide-necked bifurcation aneurysms, endoscopic endonasal clipping of intracranial aneurysms, retrosigmoid versus translabyrinthine approaches for acoustic neuromas, and impact of local intraoperative steroid administration on postoperative dysphagia following anterior cervical discectomy and fusion.

Intraoperative Corticosteroid Injection at the Time of Knee Arthroscopy Is Associated With Increased Postoperative Infection Rates in a Large Medicare Population

To employ a national database of Medicare patients to evaluate the association of ipsilateral intra-articular knee corticosteroid injections at the time of knee arthroscopy with the incidence of postoperative infection. A national Medicare insurance database was queried for patients who underwent ipsilateral intra-articular corticosteroid injection of the knee at the time of knee arthroscopy from 2005 to 2012. Patients who underwent arthroscopically assisted open procedures, those who underwent more complex arthroscopic procedures, and those for whom laterality were not coded were excluded. This study group was compared to a control cohort of patients without intraoperative steroid injections that was matched to the study group for age, gender, obesity, diabetes mellitus, and smoking status. Infection rates within 3 and 6 months postoperatively were assessed using International Classification of Diseases, 9th Revision, and Current Procedural Terminology codes. The incidence of postoperative infection rates after knee arthroscopy was significantly higher at 3 months (0.66%; odds ratio [OR], 2.6; P < .0001) and 6 months (1.92%; OR, 3.6; P < .0001) in patients who underwent ipsilateral intra-articular knee steroid injection at the time of knee arthroscopy (n= 2,866) compared with matched controls without intraoperative injections (n= 170,350) at 3 months (0.25%) and 6 months (0.54%). The present study demonstrates a significant increase in postoperative infection in Medicare patients who underwent ipsilateral intra-articular knee corticosteroid injections at the time of knee arthroscopy compared with a matched control group without intraoperative injection. Therapeutic Level III, retrospective comparative study.

Risk of Infection After Intra-articular Steroid Injection at the Time of Ankle Arthroscopy in a Medicare Population

To employ a national database to evaluate the association between intraoperative corticosteroid injection at the time of ankle arthroscopy and postoperative infection rates in Medicare patients. A national insurance database was queried for Medicare patients who underwent ankle arthroscopy, including arthroscopic removal of loose body, synovectomy, and limited or extensive debridement. Two groups were created: ankle arthroscopy with concomitant local steroid injection (n = 459) and a control group of patients who underwent ankle arthroscopy without intraoperative local steroid injection (n = 9,327). The demographics and Charlson Comorbidity Index of each group were compared. Infection rates within 6 months postoperatively were assessed using International Classification of Diseases, 9th revision, and Current Procedural Terminology codes and compared between groups using χ(2)-tests. A total of 9,786 unique patients who underwent ankle arthroscopy were included in the study. There were no statistically significant differences between the steroid injection study group and controls for the assessed infection-related variables, including gender, age group, obesity, smoking, and average Charlson Comorbidity Index. The infection rate for patients who had a local steroid injection at the time of surgery was 3.9% (18/459 patients), compared with 1.8% (168/9,327 patients) in the control group (odds ratio, 2.2; 95% confidence interval, 1.4 to 3.7; P = .002.) The majority of this difference was noted between the 65 and 79 years age groups. The use of intraoperative intraarticular corticosteroid injection at the time of ankle arthroscopy in Medicare patients is associated with significantly increased rates of postoperative infection compared with controls without intraoperative steroid injections.

The Effect of Local Intraoperative Steroid Administration on the Rate of Postoperative Dysphagia following ACDF: A National Database Study of 245,754 Patients

The Effect of Local Intraoperative Steroid Administration on the Rate of Postoperative Dysphagia following ACDF: A National Database Study of 245,754 Patients

Impact of Local Intraoperative Steroid Application on Patient-Reported Swallow Function Following Anterior Cervical Discectomy and Fusion Procedures

Impact of Local Intraoperative Steroid Application on Patient-Reported Swallow Function Following Anterior Cervical Discectomy and Fusion Procedures

Acute kidney injury: Steroids for prevention of AKI after cardiopulmonary bypass.

Cardiac surgery often requires the use of cardiopulmonary bypass, which can cause an inflammatory cascade that results in acute kidney injury (AKI). A recent post hoc analysis of a placebo-controlled, randomized trial suggests that intraoperative steroids might lower the risk of renal replacement therapy for AKI after cardiac surgery.

Patient Factors Associated with the Development of Intubation Granulomas

Objectives: While there is a well-documented association between intubation and laryngeal granuloma development, not every intubation results in granulomas. We identify patient factors associated with the development of laryngeal granulomas after endotracheal intubation and analyze the efficacy of different treatment interventions on granuloma resolution. Methods: A retrospective review of the medical records of patients treated for laryngeal granulomas after endotracheal intubation at 2 tertiary care centers between 2005 and 2013 was performed. Medical comorbidities, peri-intubation medications, and treatment modalities and outcomes were recorded. Fisher exact test was used to compare patients with laryngeal granulomas to matched control patients who did not develop granulomas after intubation. Efficacy of treatment modalities was also analyzed. Results: Twenty-three patients with laryngeal granulomas after intubation were identified and compared with controls. There was a statistically significant association between the development of laryngeal granulomas and hypertension/cardiovascular disease, obesity, renal disease, and gastroesophageal reflux ( P &lt; .05). Diabetes mellitus ( P = .137), tobacco use ( P = .253), alcohol consumption ( P = .304), peri-intubation steroid administration ( P = .339), and antibiotic administration ( P = .187) were not statistically significant. Of the granuloma patients, 13 achieved remission after treatment. Remission was achieved with surgical excision in 69.2%, with or without intraoperative steroid injection (38.4% and 30.8%, respectively). Proton pump inhibitor therapy alone was successful in 23.1%, and 7.7% resolved with inhaled steroids alone. Conclusions: Patient comorbidities likely play a role in the development of laryngeal granulomas after endotracheal intubation, while peri-intubation medications and tobacco/alcohol use do not appear to significantly impact development. Surgical excision was most effective in achieving remission.

Videothoracoscopy-assisted surgical lung biopsy for interstitial lung diseases

Surgical lung biopsy (SLB) by videothoracoscopy for diffuse interstitial lung diseases is recommended for detailed diagnosis. Because substantial mortality and morbidity are associated with this procedure, its safety and diagnostic yield should be validated. Sixty-four patients with diffuse interstitial lung disease who received SLB by videothoracoscopy between 2007 and 2013 were retrospectively analyzed for mortality, surgical complication, and diagnosis. Criteria for the procedure included patients <70-year old, who had at least 60 % vital capacity and at least 40 % diffusion capacity. Patients with radiologically definite usual interstitial pneumonia were not eligible. One conversion from the 3-port approach to thoracotomy due to bleeding occurred. Mean operation and anesthesia times were 63 and 133 min, respectively. The mean hospital stay was 6 days. Only 10 patients (16 %) received prophylactic steroid and/or elastase inhibitor administration. Neither deaths nor acute exacerbations of interstitial pneumonia occurred within 60 days after surgery. Pneumothorax occurred in four cases (6 %) after discharge, which was associated with lower % vital capacity and intraoperative steroid administration. Prolonged air leak and postoperative pneumonia were observed in 2 and 1 patients, respectively. Postoperative diagnosis was obtained in all patients. A group of connective tissue disease-related interstitial pneumonia (n = 15) and chronic hypersensitivity pneumonitis (n = 18) were the major diagnoses. Discordance between pre- and postoperative diagnoses was observed among usual interstitial pneumonia, non-specific interstitial pneumonia, and chronic hypersensitivity pneumonia. Surgical lung biopsy for diffuse interstitial lung diseases is safe under appropriate inclusion criteria and provides definite diagnosis.

Impact of the pediatric tonsillectomy and polysomnography clinical practice guidelines

ObjectiveTo evaluate the effect of the recently published guidelines on Tonsillectomy in Children and Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children on physician practice patterns. Study designCross-sectional survey. MethodSurvey of members of the American Academy of Otolaryngology—Head and Neck Surgery. SettingAcademic tertiary referral center. ResultsA total of 280 physicians completed the survey, with a response rate of 41.7%. 93% of respondents had read the clinical practice guidelines. Many respondents had completed a pediatric otolaryngology fellowship (46%). A large group of physicians (46%) continue to prescribe antibiotics within 24h after surgery. One-third of respondents stopped prescribing antibiotics because of the guidelines. Discord between severity of symptoms and tonsil size was the most common reason cited for ordering a polysomnogram prior to tonsillectomy (76%). The most common reason cited for admission post-tonsillectomy was age less than 3 (40%). Less than half of physicians prescribe NSAIDs for pain control (43.8%) despite its safety profile, and only 23% reported that the guidelines influenced their use of NSAIDs postoperatively. Most respondents use intra-operative steroids (90%) as recommended. ConclusionThe guidelines are intended to provide evidence based direction in tonsillectomy practices and improve referral patterns for polysomnography prior to tonsillectomy. The majority of the surveyed otolaryngologists reviewed these guidelines and some have changed their practice secondary to the guidelines. However, many physicians continue to prescribe post-operative antibiotics and do not use NSAIDs.

Elbow arthroscopy: early complications and associated risk factors

Elbow arthroscopy is increasingly used to treat complex pathology. The purpose of this study was to investigate early complication rates after elbow arthroscopy and identify risk factors for adverse events. Consecutive elbow arthroscopies performed during a 13-year period were reviewed, identifying early perioperative complications. Major complications included deep infection, permanent nerve injury, or complications requiring additional anesthesia. Minor complications included superficial wound complications and transient nerve palsies. Complications were compared with a surgical complexity scale based on the procedure performed, the number of arthroscopic portals, and tourniquet time. Of 417 procedures, there were 37 minor (8.9%) and 20 major (4.8%) complications. The rates of superficial and deep infections were 6.7% and 2.2%, respectively. Major complications included 9 deep infections, 6 cases of heterotopic ossification requiring further surgery, and 4 manipulations under anesthesia. There were 7 transient sensory nerve complications, and no motor deficits. No differences in complication rates were seen between low-, moderate-, and high-complexity (10.2%, 16.3% and 14.4%, respectively) cases. Intraoperative steroid injections were strongly associated with postoperative superficial (14.1% vs 2.0%) and deep infection (4.9% vs 0.4%) in elbows receiving vs those not receiving steroid (P < .0001). Complications of elbow arthroscopy are seen in approximately 14% of cases. Most complications are minor, not affecting clinical outcome. Major complications occur in 5% of cases, often requiring repeat surgery. Intraoperative postsurgical steroid injections are associated with increased risk of perioperative infections. Case complexity does not appear to affect the rate of complications with modern surgical techniques.

Post-operative steroids in the management of capsulitis following TMJ arthroscopy

Post-operative steroids in the management of capsulitis following TMJ arthroscopy

Effects of intraoperative steroid injection on the outcome of pterygium surgery

To evaluate the effects of intraoperative triamcinolone injection on the outcome of pterygium surgery. This prospective study included 54 eyes with primary nasal pterygia that underwent pterygium surgery with a bare-sclera technique and intraoperative mitomycin C application. Patients were randomized into two groups; the steroid group that received subconjunctival injection of 12 mg triamcinolone acetonide at the end of surgery, and the control group that did not receive such steroid injection. Main outcome measures included presence of conjunctival inflammation at 1 month postoperatively as well as recurrence of pterygium. Twelve-month follow-up was completed in 48 eyes (23 in the steroid group and 25 in the control group). At 1 month postoperatively, different grades of conjunctival inflammation were present in 11 (47.8%) of the steroid group and in 14 (56%) of the control group (P=0.39). For eyes with moderate or severe postoperative inflammation, subconjunctival triamcinolone was injected; these included 6 (26.1%) and 9 (36%) in the steroid and control groups, respectively (P=0.54). During follow-up, surgical area showed fine episcleral vessels without fibrous tissue in 1 (4.3%) of the steroid group and 3 (12.0%) of the control group (P=0.33), which all regressed after triamcinolone injection. Conjunctival recurrence of pterygium was seen in 2 (8.7%) of the steroid group and in 1 (4.0%) of the control group (P=0.47). No eye developed corneal recurrence in either group. In pterygium surgery with a bare-sclera technique and mitomycin C application, intraoperative triamcinolone injection did not significantly reduce postoperative conjunctival inflammation or pterygium recurrence.

The influence of steroid administration on systemic response in laminoplasty for cervical myelopathy

The excessive systemic inflammatory response caused by surgery has been associated with the development of major complications, such as postoperative confusion and acute respiratory distress syndrome. The serum IL-6 has been used as a predictor in the extent of surgical trauma. Several trials have reported that steroid administration reduced excessive systemic response. We investigated the systemic response caused by surgical trauma in patients with cervical laminoplasty and evaluated the influence of steroid administration on systemic response. Thirty patients were included in this study. The patients were divided into three groups of ten each: preoperative steroid group, intraoperative steroid group, and non-steroid group. The same dose of steroid was administered to the patients in preoperative group and intraoperative group. Venous blood samples were taken at the following times: before surgery, at the end of surgery, 6 h after the surgery, the first, the third and the seventh day after the surgery. Outcome measures were serum IL-6, IL-10, C-reactive protein (CRP), white blood cells including neutrophil and lymphocyte counts. The mean serum IL-6 levels on the first day in preoperative and intraoperative steroid groups were significantly lower than in control group. The serum IL-6 levels in preoperative steroid group were lower than the serum levels in the intraoperative steroid group from the end of surgery to the third day after surgery. The CRP levels in steroids groups were also lower than in control group on the third day. There were no significant differences in the postoperative neutrophil count between the three groups. There was no postoperative infectious complication or suture failure. This study shows that the preoperative administration of steroids modified the systemic inflammatory response caused by surgical trauma in patients with cervical laminoplasty.

Peri-operative interventions, but not inflammatory mediators, increase risk of acute kidney injury after cardiac surgery: a prospective cohort study

Cardiopulmonary bypass (CPB)-related inflammatory response might be one mechanism by which cardiac surgery associated acute kidney injury (CS-AKI) occurs. Interventions that may attenuate inflammation, including glucocorticoids or phosphodiesterase inhibitors, could therefore have a role in its prevention. We aimed to determine the role of inflammatory mediators in CS-AKI in children and the efficacy of commonly used peri-operative interventions to reduce CS-AKI risk. We prospectively studied 109 children undergoing heart surgery. Using regression modeling (adjusting for covariates), we (1) evaluated the association between inflammatory mediators [interleukin (IL)-6, IL-8, C-reactive protein, and tumor necrosis factor-α levels] and CS-AKI, and (2) evaluated risk/prevention factors for CS-AKI including glucocorticoid and milrinone administration. CS-AKI was defined based on pRIFLE methods. CS-AKI occurred in 68% of children. No inflammatory mediator measured had an independent association with CS-AKI. Higher pre-operative glomerular filtration rate (GFR), sustained decrease in mean arterial pressure during CPB, post-operative single ventricle physiology, deep hypothermic circulatory arrest, and milrinone use at 24 h post-operatively were significant independent predictors of CS-AKI. Intra-operative steroid administration had no effect on the rate of CS-AKI. Although inflammatory mediators are up-regulated following CPB, we found no association between levels of inflammatory cytokines and CS-AKI. CS-AKI has complex pathophysiology and the observation that milrinone was associated with increased AKI risk (and that higher GFR predicts more injury) suggests that mechanisms beyond inflammation play a significant role. Intra-operative administration of glucocorticoid does not appear to be an effective intervention for reducing the risk of CS-AKI.

Comparison between preoperative administration of methylprednisolone with its administration before and during congenital heart surgery on serum levels of IL-6 and IL-10.

BackgroundSteroid administration during cardiopulmonary bypass is considered to improve cardiopulmonary function by modulating inflammations caused by bypass.ObjectivesThis study was performed to compare effectiveness of preoperative and intraoperative methylprednisolone (MP) to preoperative methylprednisolone alone in post bypass inflammatory (IL-6) and anti-inflammatory (IL-10) factors.Patients and MethodsFifty pediatric patients undergoing cardiopulmonary bypass surgery from August 2011 to 2012 in the cardiac surgery department of Imam Reza Hospital, the major center for CPB, in Mashhad, Iran were randomly assigned to receive preoperative and intraoperative MP (30 mg/kg, 4 hours before bypass and in bypass prime, number 25) or preoperative MP only (30 mg/kg, number 25). Before and after bypass, four and 24 hours after bypass, serum IL-6 and IL-10 were measured by ELISA.ResultsIn both groups, no significant difference with variation of expression for IL-6 (inflammatory factor) and IL-10 (anti-inflammatory factor) in different times after bypass was observed.ConclusionsNo significant difference in reducing post bypass inflammation between preoperative steroid treatment and combined preoperative and intraoperative steroid administration reported and they had the same effects.

The postoperative cortisol stress response following transsphenoidal pituitary surgery: a potential screening method for assessing preserved pituitary function

The ability to reliably identify patients with new hypocortisolemia acutely following pituitary surgery is critical. We aimed to quantify the postoperative cortisol stress response following selective transsphenoidal adenomectomy, as a marker for postoperative preservation of functional pituitary gland. Records of 208 patients undergoing transsphenoidal operations for pituitary lesions were reviewed. Patients with Cushing's Disease, preoperative adrenal insufficiency, and those receiving intraoperative steroids were excluded. To quantify the postoperative stress response, the ∆ cortisol index was defined as the postoperative day (POD) 1 morning cortisol minus the preoperative morning cortisol level. The incidence of new hypocortisolemia requiring glucocorticoid replacement upon hospital discharge was also recorded. Fifty-two patients met inclusion criteria. The mean preoperative, POD1, and POD2 cortisol levels were 16.5, 29.2, and 21.8 μg/dL, respectively. Morning fasting cortisol levels on POD1 ranged from 4.2 to 73.0 μg/dL. The ∆ cortisol index ranged from -19.0 to +56.2 (mean +12.7 μg/dL). Five patients (9.6%) developed new hypocortisolemia on POD 1-3 requiring glucocorticoid replacement; only one required long-term replacement. The mean ∆ cortisol in patients requiring postoperative glucocorticoids was -2.8 μg/dL, compared with +14.4 μg/dL in patients without evidence of adrenal insufficiency (p = 0.005). Of the 32 patients (61.5%) with a ∆cortisol >25 μg/dL, none developed postoperative adrenal insufficiency. The postoperative cortisol stress response, as quantified by the ∆ cortisol index, holds potential as a novel and complimentary screening method to predict preservation of normal pituitary function and acute development of new ACTH deficiency following transsphenoidal pituitary surgery.

Impact of Tonsillectomy Clinical Practice Guidelines

Objective: To evaluate the effect of the recently published pediatric tonsillectomy and polysomnography clinical guidelines on current practice patterns. Method: An anonymous 15-question survey was sent to members of the American Academy of Otolaryngology–Head and Neck Surgery regarding their awareness of the Clinical Practice Guideline: Tonsillectomy in Children and Clinical Practice Guideline: Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children and whether or not they have changed their practice as a result. Results: A total of 93% of respondents read the guidelines. Most respondents had completed a pediatric otolaryngology fellowship (84%). A small majority of physicians (54%) continue to prescribe antibiotics within 24 hours after surgery. One-third of respondents stopped prescribing antibiotics because of the new guidelines. Discord between severity of symptoms and tonsil size was the most common reason cited for ordering a polysomnogram prior to tonsillectomy (76%) in concordance with the guideline’s recommendations. A total of 45% of physicians prescribe NSAIDs for pain control despite its safety profile, and 23% reported that the guidelines influenced their use of NSAIDs postoperatively. Most respondents use intraoperative steroids (90%). Conclusion: The guidelines are intended to provide evidence- based direction in tonsillectomy practices and improve referral patterns for polysomnography prior to tonsillectomy. A majority of the surveyed otolaryngologists reviewed these guidelines. There is some evidence practice has changed secondary to the guidelines.

Efficacy of intraoperative, single-bolus corticosteroid administration to prevent postoperative acute respiratory failure after oesophageal cancer surgery

Respiratory failure from acute lung injury (ALI), acute respiratory distress syndrome (ARDS) and pneumonia are the major cause of morbidity and mortality following an oesophagectomy for oesophageal cancer. This study was performed to investigate whether an intraoperative corticosteroid can attenuate postoperative respiratory failure. Between November 2005 and December 2008, 234 consecutive patients who underwent an oesophagectomy for oesophageal cancer were reviewed. A 125-mg dose of methylprednisolone was administered after performing the anastomosis. ALI, ARDS and pneumonia occurring before postoperative day (POD) 7 were regarded as acute respiratory failure. The mean age was 64.2 ± 8.7 years. One hundred and fifty-one patients were in the control group and 83 patients in the steroid group. Patients' characteristics were comparable. The incidence of acute respiratory failure was lower in the steroid group (P = 0.037). The incidences of anastomotic leakage and wound dehiscence were not different (P = 0.57 and P = 1.0). The C-reactive protein level on POD 2 was lower in the steroid group (P < 0.005). Multivariate analysis indicates that the intraoperative steroid was a protective factor against acute respiratory failure (P = 0.046, OR = 0.206). Intraoperative corticosteroid administration was associated with a decreased risk of acute respiratory failure following an oesophagectomy. The laboratory data suggest that corticosteroids may attenuate the stress-induced inflammatory responses after surgery.