Document Detail


Risks and benefits of preoperative high dose methylprednisolone in surgical patients: a systematic review.
MedLine Citation:
PMID:  11085349     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: A single preoperative high dose of methylprednisolone (15 to 30 mg/kg) has been advocated in surgery, because it may inhibit the surgical stress response and thereby improve postoperative outcome and convalescence. However, these potential clinical benefits must be weighed against possible adverse effects. OBJECTIVE: To conduct a risk-benefit analysis using a meta-analysis, to compare complication rates and clinical advantages associated with the use of high dose methylprednisolone in surgical patients. METHODS: Randomised controlled trials of high dose methylprednisolone in elective and trauma surgery were systematically searched for in various literature databases. Outcome data on adverse effects, postoperative pain and hospital stay were extracted and statistically pooled in fixed-effects meta-analyses. RESULTS: We located 51 studies in elective cardiac and noncardiac surgery, as well as traumatology. Pooled data failed to show any significant increase in complication rates. In patients treated with corticosteroids, nonsignificantly more gastrointestinal bleeding and wound complications were observed; the 95% confidence interval boundaries of the numbers-needed-to-harm were 59 and 38, respectively. The only significant finding was a reduction of pulmonary complications (risk difference -3.5%; 95% confidence interval -1.0 to -6.1), mainly in trauma patients. CONCLUSION: For patients undergoing surgical procedures, a perioperative single-shot administration of high dose methylprednisolone is not associated with a significant increase in the incidence of adverse effects. In patients with multiple fractures, limited evidence suggests promising benefits of glucocorticoids on pulmonary complications.
Authors:
S Sauerland; M Nagelschmidt; P Mallmann; E A Neugebauer
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Drug safety : an international journal of medical toxicology and drug experience     Volume:  23     ISSN:  0114-5916     ISO Abbreviation:  Drug Saf     Publication Date:  2000 Nov 
Date Detail:
Created Date:  2001-02-07     Completed Date:  2001-02-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9002928     Medline TA:  Drug Saf     Country:  NEW ZEALAND    
Other Details:
Languages:  eng     Pagination:  449-61     Citation Subset:  IM    
Affiliation:
2nd Department of Surgery, University of Cologne, Germany. S.Sauerland@uni-koeln.de
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MeSH Terms
Descriptor/Qualifier:
Animals
Anti-Inflammatory Agents / administration & dosage*,  adverse effects*
Humans
Methylprednisolone Hemisuccinate / administration & dosage*,  adverse effects*
Premedication*
Preoperative Care*
Randomized Controlled Trials as Topic
Risk Assessment
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents; 2921-57-5/Methylprednisolone Hemisuccinate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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