Abstract
High doses of corticosteroids have been found to have beneficial effects in various shock states. It has been well recognized that ischaemia is one of the important features in shock states. This prompted us to investigate the effect of high-dose methylprednisolone on tourniquet-induced ischaemia using mongrel dogs. After inflation of tourniquets to 600 mmHg on each thigh of the hind legs, one leg received an intravenous infusion of methylprednisolone, 3 mg · kg-1 dissolved in 20 ml of autologous blood. The other leg received the same amount of blood only, as a control. During two hours of tourniquet time and until 30 min after tourniquet deflation, venous blood was sampled five times from both hind legs for measurements of blood gas tensions (PvO2, PvCO2) and pH, lactic acid, creatinine kinase (CK), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH). During tourniquet ischaemia, PvO2 and pH dropped and PvCO2, lactic acid, CK, AST and LDH rose steadily and significantly in both groups of legs, indicating respiratory and metabolic acidosis, and muscle cell damage. However, those changes were significantly smaller in the methylprednisolonetreated legs. The beneficial effect of methylprednisolone could be attributed to its vasodilatory effect, cellular membrane stabilization and direct metabolic effect on skeletal muscle cells. Although the tourniquet-induced ischaemia in our study is slightly different from the clinical paradigm, the results suggest that high-dose methylprednisolone may provide a beneficial effect during tourniquet ischaemia.
Résumé
Des doses élevées de corticostéroïdes ont été trouvées bénéfiques dans différents états de choc. Il est bien reconnu que ľischémie est un signe important des états de choc. Ceci nous a conduit à investiguer ľeffet de doses élevées de méthylprednisolone sur ľischémie induite par le tourniquet chez les chiens bâtards. Après inflation du tourniquet à 600 mmHg sur chaque cuisse des pattes arrière, une patte a reçu la perfusion intraveineuse de 3 mg · kg-1 de méthylprednisolone dissout dans 20 ml de sang autologue. Ľautre patte a reçu la même quantité de sang et fut utilisée comme contrôle. Pendant deux heures du temps ďischémie par tourniquet et 30 minutes après la déflation du tourniquet le sang veineux a été retiré à cinq reprises des deux pattes pour fin de gazométrie (PvO2, PvCO2) pH, acide lactique, créatine pattes pour fin de gazométrie (PvO2, PvCO2) pH, acide lactique, créatine kinase (CK), aspartate aminotransférase (AST) et déhydrogénase lactique (LDH). Durant ľischémie provoquée par le tourniquet, la PvO2 et pH diminuèrent et la PvCO2, ľacide lactique, la CK, ľAST et le LDH augmentèrent progressivement et significativement dans les deux groupes de pattes indiquant une acidose métabolique et respiratoire ainsi qu’une lésion de la cellule musculaire. Cependant, ces changements étaient significativement moindres pour les pattes traitées au methylprednisolone. Ľeffet bénéfique de la méthylprednisolone pourra être attribué à son effet vasodilatateur, son effet stabilisateur de la membrane cellulaire et un effet métabolique direct sur la cellule musculaire squelettique. Même si le temps ďischémie induit par le tourniquet dans notre étude est légèrement différent de la clinique, les résultats suggèrent que les doses élevées de méthylprednisolone peuvent amener un effet bénéfique sur ľischémie provoquée par le tourniquet.
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Goto, H., Benson, K.T., Katayama, H. et al. Effect of high-dose of methylprednisolone on tourniquet ischaemia. Can J Anaesth 35, 484–488 (1988). https://doi.org/10.1007/BF03026896
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DOI: https://doi.org/10.1007/BF03026896