Abstract
It is difficult to manage unstable circulation and prolonged respiratory failure related to SIRS (systemic inflammatory response syndrome) induced by surgical stress after radical esophageal surgery.
Glucocorticoid (methylprednisolone 10mg·kg-1) was administered to patients immediately after radical esophageal surgery to control excessive reactions induced by surgical stress. The efficacy of glucocorticoid in the steroid group (N=8) and the control group (N=12, no treatment) was compared.
Plasma cytokine (interleukin-6 and 8) levels in the steroid group were significantly lower than those in the control group on the first postoperative day. Half as much fresh frozen plasma was needed to maintein total plasma protein and urine volume in the steroid group over 7 postoperative days. The intubation period of patients in the steroid group was significantly shorter than in the control group. Adverse effects of steroids such as abnormalities in glucose tolerance, infection, or delay in wound healing did not appear.
These results suggest that single postoperative administration of glucocorticoid can prevent excessive release of cytokines induced by surgical stress and can reduce the loss of plasma to the interstitial spaces caused by the hyperpermeability of the systemic capillary vessels.
Glucocorticoid did not shorten the length of admission, but decreased the amount of fresh frozen plasma transfusion, shortened intubation periods, and was very useful for postoperative management in patients with radical esophageal surgery.
