Skip to main content
SpringerLink
Log in

Massive doses of methylprednisolone (30 mg/kg) in man: Immediate haemodynamic effects in “low output state”

  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Methylprednisolone, 30 mg/kg body-weight, was given as an intravenous bolus injection to a total of 31 cardiosurgical patients.

Measurements of left ventricular parameters showed no significant increase in dp/dtmax and no significant decrease in left ventricular end-diastolic pressure. There were no important changes in blood pressure, heart rate, cardiac index, stroke index and total peripheral resistance.

During ‘steady state’ extracorporeal circulation no relevant vasodilating effect could be found.

In comparison to a control-group there were no important differences in haemodynamic parameters.

In cardio-surgical patients, — mainly functional class III — we were unable to demonstrate any gross cardiovascular effects of large doses of methylprednisolone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Beardsley, A.C., Okuda, M., Lefer, A.M.: Absence of a cardiodynamic action of glucocorticoids in acute myocardial ischemia. J. surg. Res. 20, 17 (1976)

    PubMed  Google Scholar 

  2. Carter, J.W., Thomas, C.S.: The circulatory response to pharmacological levels of hydrocortisone. J. surg. Res. 10, 437 (1970)

    PubMed  Google Scholar 

  3. Dietzman, R.H., Lillehei, F.C.: The treatment of cardiogenic shock. Amer. Heart J. 75, 284 (1968)

    Google Scholar 

  4. Dietzman, R.H., Lillehei, R.C.: The treatment of cardiogenic shock V. The use of steroids. Amer. Heart J. 75, 274 (1968)

    PubMed  Google Scholar 

  5. Dietzman, M.D., Ersek, R.A., Lillehei, C.W., Castaneda, A.R., Lillehei, R.C.: Low output syndrome; recognition and treatment. J. thorac. cardiovasc. Surg. 57, 138 (1969)

    Google Scholar 

  6. Dietzman, R.H., Motsay, F.J., Lillehei, R.C.: Die Anwendung von Arzneimitteln bei der Schock-Behandlung. Internist 12, 103 (1971)

    PubMed  Google Scholar 

  7. Engquist, A., Sorensen, B., Kann, T.: Supraphysiologic glucocorticoid treatment in hypoxic stress in dogs. Acta anaesth. scand. 20, 351 (1976)

    PubMed  Google Scholar 

  8. Glenn, T.M., Lefer, A.M., Martin, J.B., Lovett, W.L., Norris, J.N., Jr., Wangensteen, S.L.: Production of a myocardial depressant factor in cardiogenic shock. Amer. Heart. J. 82, 78 (1971)

    PubMed  Google Scholar 

  9. Gould, L., Ramana Reddy, C.V., Narayana Swamg, C.R., Chua, W., Dorismond, J.Cl.: Hemodynamic effects of steroids in cardiac disease. Amer. Heart J. 92, 133 (1976)

    PubMed  Google Scholar 

  10. Gunnar, R.M., Loeb, H.S.: Drugs in the treatment of shock. Drugs in Cardiology, Part 1: Current Cardiovascular Topics, Vol. I (ed. E. Donoso), p. 183. Stuttgart: Thieme 1975

    Google Scholar 

  11. Hinshaw, L.B., Archer, L.T., Black, M.R., Greenfield, L.J.: Effects of methylprednisolone sodium succinate on myocardial performance, hemodynamics, and metabolism in normal and failing hearts. In Steroids and shock (ed.: T.M. Glenn), München, Berlin, Wien: Urban & Schwarzenberg 1975

    Google Scholar 

  12. Hinshaw, L.B., Solomon, L.A., Freeny, P.C., Reins, D.A.: Endotoxin shock: haemodynamic and survival effects of methylprednisolone. Arch. Surg. 94, 61 (1967)

    PubMed  Google Scholar 

  13. Kadowitz, P.J., Yard, A.C.: Circulatory effects of hydrocortisone and protection against endotoxin shock in cats.

  14. Lefer, A.M., Glenn, T.M.: Corticosteroids and the lysosomal protease — myocardial depressant factor system in shock. In: Steroids and Shock (ed.; T.M. Glenn) München, Berlin, Wien, Urban & Schwarzenberg 1975

    Google Scholar 

  15. Lefer, Am.M., Glenn, T.M.: Interaction of lysosomal hydrolases and a myocardial depressant factor in the pathogenesis of circulatory shock. In: Shock in low- and high-flow States, B.K. Forscher, R.C. Lillehei, and S.S. Stubbs, eds. pp. 88–105, Amsterdam: Excerpta Medica 1972

    Google Scholar 

  16. Lefer, A.M., Martin, J.: Mechanism of the protective effect of corticosteroids in hemorrhagic shock: Amer. J. Physiol. 216, 314 (1969)

    PubMed  Google Scholar 

  17. Libby, P., Maroko, P.R., Bloor, C.M., Sobel, B.E., Braunwald, E.: Reduction of experimental myocardial infarction size by corticosteroid administration. J. clin. Invest. 52, 599 (1973)

    PubMed  Google Scholar 

  18. Lillehei, R.C., Dietzman, R.H., Gearge, Ph.D., Motsay, J., Beckman, Ch.B., Romero, L.H., Shatney, C.H.: Growth of the concept of shock and review of present knowledge. In: Steroids and shock (ed.: T.M. Glenn) München, Berlin, Wien: Urban & Schwarzenberg 1975

    Google Scholar 

  19. Lillehei, R.C., Motsay, G.J., Dietzman, R.H.: The use of corticosteroids in the treatment of shock. Int. J. clin. Pharmacol. 54, 423 (1972)

    Google Scholar 

  20. Morrison, J., Reduto, L., Maley, T., Gulotts, S.: Protection of ischemic myocardium in man by methylprednisolone. Amer. J. Cardiol. 35, 158 (1975)

    Google Scholar 

  21. Motsay, G.J., Alho, A.V., Dietzman, R.H., Schultz, L.S., Romero, L.H., Lillehei, R.C.: Fore limb, small intestine, and pulmonary vascular beds in canine endotoxine shock. In: Steroids and Shock (ed.: T.M. Glenn), München, Berlin, Wien: Urban & Schwarzenberg 1975

    Google Scholar 

  22. Motsay, G.J., Alho, A., Jaeger, Th., Dietzman, R.H., Lillehei, R.C.: Effects of corticosteroids on the circulation in shock: experimental and clinical results. Fed. Proc. 29, 1861 (1970)

    PubMed  Google Scholar 

  23. Osher, J., Tzu-Wang, Lang, Meerbaum, S., Hashimoto, K., Farcot, J.-Ch., Corday, E.: Methylprednisolone treatment in acute myocardial infarction. Effect on regional and global myocardial function. Amer. J. Cardiol. 37, 564 (1976)

    PubMed  Google Scholar 

  24. Piepenbrock, S., Hempelmann, G., Dragojevic, D.: Intensivmedizinische Überwachung von Patienten nach Herzoperationen unter besonderer Berücksichtigung des Herzzeit-volumens. Prakt. Anästh. 9, 211 (1974)

    Google Scholar 

  25. Rao, P.S., Cavanagh, D.: Endotoxic shock in the baboon: some effects of glucocorticoid therapy. Surg. Forum 21, 416 (1970)

    PubMed  Google Scholar 

  26. Roberts, R., De Mello, V., Sobel, B.E.: Deleterious effects of methylprednisolone in patients with myocardial infarction. Circulation 53, Suppl. I. 204 (1976)

    PubMed  Google Scholar 

  27. Sambhi, M.P., Weil, M.H., Udhoji, V.N.: Increase in cardiac output: a pharmacologic effect of corticosteroids. Circulation 26, 780 (1962)

    Google Scholar 

  28. Sambhi, M.P., Weil, M.H., Udhoji, V.N.: Cardiac output and related hemodynamic changes in normal subjects and patients in shock. Circulation 31, 523 (1965)

    PubMed  Google Scholar 

  29. Sambhi, M.P., Weil, M.H., Udhoji, V.N., Shubin, H.: Adrenocorticoids in the management of shock. Int. Anesth. Clin. 2, 421 (1964)

    Google Scholar 

  30. Sayers, G., Solomon, N.: Work performance of a rat heart-lung preparation: standardization and influence of corticosteroids. Endocrinology 66, 719 (1960)

    PubMed  Google Scholar 

  31. Schultz, L.S., Alho, A.V., Dietzman, R.H., Ersek, R.A., Motsay, G.J., Romero, L.H., Ruiz, J.O.: Pharmacological assistance in the low-output syndrome. Shock in Low and High Flow States. (eds.: B.K. Forscher, R.C. Lillehei, S.S. Stubbs). Amsterdam: Excerpta medica 247 (1972)

    Google Scholar 

  32. Schumer, W.: Dexamethasone in oliguric shock. Arch. Surg. 98, 259 (1969)

    PubMed  Google Scholar 

  33. Shoemaker, W.C., Brown, R.S., Mohr, P.A., Monson, D.O., Carey, J.S.: The cardiovascular system. Corticosteroids in the Treatment of Shock (eds. W. Schumer, L. Nyhus). Urbana; University of Illinois Press 19...

  34. Shatney, C.H., Maccarter, D.J., Lillehei, R.C.: Effects of allopurinol, propranolol and methylprednisolone on infarct size in experimental myocardial infarction. Amer. J. Cardiol. 37, 572 (1976)

    PubMed  Google Scholar 

  35. Spath, J.A., Jr., Lane, D.L., Lefer, A.M.: Protective action of methylprednisolone on the myocardium during experimental myocardial ischemia in the cat. Circulat Res. 35, 44 (1974)

    PubMed  Google Scholar 

  36. Talley, R.C., Beller, B.M.: Methylprednisolone in high resistance shock. Circulation 44, Suppl. 2, II (1971)

    Google Scholar 

  37. Tanz, R.D., Kerby, C.F.: The inotropic action of certain steroids upon isolated cardiac tissue; with comments on steroidal cardiotonic structure-activity relationships. J. Pharmacol. exp. Ther. 131, 56 (1961)

    PubMed  Google Scholar 

  38. Tecklenberg, P.L., Mullin, E.M., Stinson, E.B., Morrow, A.G.: The effects of massive doses of methylprednisolone on myocardial contractility and peripheral vascular resistance. Amer. Heart J. 85, 216 (1973)

    PubMed  Google Scholar 

  39. Vyden, J.K., Nagasawa, K., Corday, E., Parmley, W.W., Swan, H.J.C.: Hemodynamic aspects of corticosteroid administration in the treatment of acute myocardial infarction. In: Steroids and Shock (ed.: T.M. Glenn) München, Berlin, Wien: Urban & Schwarzenberg 1975

    Google Scholar 

  40. Wilson, R.F., Ali, M., Anand, V., McCarthy, B., Pitt, J., Hayes, D., Percinel, A., LeBlanc, L.P.: Effects of vasoactive agents in clinical septic shock. In: Shock in Low- and High-Flow States B.K. Forscher, R.C. Lillehei, S.S. Stubbs, eds. pp. 269–281, Amsterdam: Excerpta Medica 1972

    Google Scholar 

  41. Wilson, F.R., Fischer, R.R.: The hemodynamic effects of massive steroids in clinical shock. Surg. Gynec. Obstet. 127 769 (1968)

    PubMed  Google Scholar 

  42. Winslow, E.J., Loeb, H.S., Rahimtoola, S.H., Kamath, S., Gunnar, R.M.: Hemodynamic studies and results of therapy in 50 patients with bacteriemic shock. Amer. J. Med. 54, 421 (1973)

    PubMed  Google Scholar 

  43. Winslow, E., Loeb, H., Rahimtoola, S., Gunnar, R.: Absence of hemodynamic improvement following massive dosages of corticosteroids in septic shock. Clin. Res. 19, 345 (1971)

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Anesthesiology, Medical School, Karl-Wiechert-Allee 9, D-3000, Hannover 61, FRG

    Siegfried Piepenbrock, Gunter Hempelmann & Cord Westermann

  2. Department of Surgery, Medical School, Hannover, FRG

    Siegfried Piepenbrock, Gunter Hempelmann & Cord Westermann

Authors
  1. Siegfried Piepenbrock
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gunter Hempelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cord Westermann
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Piepenbrock, S., Hempelmann, G. & Westermann, C. Massive doses of methylprednisolone (30 mg/kg) in man: Immediate haemodynamic effects in “low output state”. Intensive Care Med 3, 69–76 (1977). https://doi.org/10.1007/BF01683064

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01683064

Key words

Search

Navigation