The Perioperative Antiinflammation Effect Of A Single Dose Of Prednisolone And Dexamethasone

Objective:To discuss the perioperative effect of a single-dose of dexamethasone and prednisolone in paitients undergoing thoracoscopic lobectomy.Methods:Forty-five patients (ASA Ⅰ-Ⅱ) undergoing thoracoscopic lobectomy were randomly divided into three groups (n=15). Prednisolone 0.6mg/kg Group A) or dexamethasone 0.1mg/kg (Group B) or saline (Group C) was given 30min before anesthesia. Anesthesia was induced with intravenous injection of midazolam, fentanyl, etomidate and rocuronium subsequently, and was maintained with sevoflurane and interval injection of sufentanil and rocuronium. Postoperative analgesia was PCIA with fentanyl, dezocine, lappaconitine and azasetron. Serum TNF-α, IL-2, IL-6, IL-10 and cortisol was detected at pre-administration (T0), 1h after incision (T1), at the end of surgery (T2),8am of the 1st postoperative day (T3), and 8am of the 2nd postoperative day (T4), respectively. Postoperative pulmonary complications, wound healing, and postoperative recovery conditions were observed after the surgery.Results:1. No significant differences was found between the three groups in general data.2. There were no differences in time of one-lung ventilation, dosages of sufentanil and rocuronium (p>0.05).3. TNF-a, IL-2, IL-6, IL-10 and cortisol: (1)Serum TNF-a, IL-2, IL-6and cortisol in Group C began to increase from T1, TNF-a, IL-2 and cortisol reached the peak at T2 (p<0.05), then declined. While the concentration of IL-6 was highest at T3 (p<0.05). In Group A, the level of TNF-a, IL-2, IL-6 and cortisol were all lower than Group C from T2 to T3 (p<0.05). And TNF-a, IL-2 and cortisol of Group B were all lower than Group C from T3 to T4 (p<0.05). (2) Serum IL-10 in Group C started to raise at T1, and the highest was observed at T2 (p<0.05), then declined. The level in Group A was obviously higher at T2 than TO (p<0.01). In Group B, the concentration at T4 was the highest (p<0.01), and also higher then T4 of Group C (p<0.05).4. Postoperative conditions:The incidence of pulmonary complication, wound healing and hospital length of stay after surgery of the three groups all had no statistically significant.Conclusions:Surgery leads to stress and increasing release of inflammatory cytokines and cortisol. Single dose of dexamethasone and prednisolone can suppress the systemic inflammatory response and play a good role in postoperative recovery. Prednisolone have a faster onset time and less inhibition of adrenal function after surgery than dexamethasone, which demonstrated that prednisolone might be more suitable to decrease the perioperative inflammatory response.