Abstract
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, aswell 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.
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References
Walsh LJ, Wong CA, Pringle M, et al. Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ 1996; 313: 344–6
Boston Collaborative Drug Surveillance Program. Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol 1972; 13: 694–8
Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis 1989; 11: 954–63
Messer J, Reitman D, Sacks HS, et al. Association of adrenocorticosteroid therapy and peptic-ulcer disease. N Engl J Med 1983; 309: 21–4
Conn HO, Poynard T. Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Intern Med 1994; 236: 619–32
Robbins JJ. Steroid side effects, a credibility gap between fact and opinion [letter]. N Engl J Med 1968; 279: 328
Tuft L. “Steroid-phobia” in asthma management. Ann Allergy 1979; 42: 152–9
Cronstein BN, Kimmel SC, Levin RI, et al. A mechanism for the antiinflammatory effects of corticosteroids: the glucocorticoid receptor regulates leukocyte adhesion to endothelial cells and expression of endothelial-leukocyte adhesion molecule 1 and intercellular adhesion molecule 1. Proc Natl Acad Sci USA 1992; 89: 9991–5
Weiler JM, Packard BD. Methylprednisolone inhibits the alternative and amplification pathways of complement. Infect Immun 1982; 38: 122–6
Buttgereit F, Dimmeler S, Neugebauer E, et al. Mechanisms of action of high-dosage glucocorticoid therapy [in German]. Dtsch Med Wochenschr 1996; 121: 248–52
Hall ED. The neuroprotective pharmacology of methylprednisolone. J Neurosurg 1992; 76: 13–22
Munck A, Naray-Fejes-Toth A. Glucocorticoids and stress: permissive and suppressive actions. Ann NY Acad Sci 1994; 746: 115–30
Lipworth BJ. Therapeutic implications of non-genomic glucocorticoid activity. Lancet 2000; 356: 87–9
Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 1990; 322: 1405–11
Bracken MB, Shepard MJ, Collins WF, Jr., et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study. J Neurosurg 1992; 76: 23–31
Bracken MB. Pharmacological interventions for acute spinal cord injury [Cochrane Review]. In: Cochrane Collaboration, editor. The Cochrane Library, Issue 1/2000 [CD-ROM]. Oxford/UK: Update Software, 2000
Alderson P, Roberts I. Corticosteroids in acute traumatic brain injury [Cochrane Review]. In: Cochrane Collaboration, editor. The Cochrane Library, Issue 1/2000 [CD-ROM]. Oxford/UK: Update Software, 2000
Dietzman RH, Lunseth JB, Goott B, et al. The use of methylprednisolone during cardiopulmonary bypass. A review of 427 cases. J Thorac Cardiovasc Surg 1975; 69: 870–3
Rokkanen P, Alho A, Avikainen V, et al. The efficacy of corticosteroids in severe trauma. Surg Gynecol Obstet 1974; 138: 69–73
Svennevig JL, Bugge-Asperheim B, Bjorgo S, et al. Methylprednisolone in the treatment of lung contusion following blunt chest trauma. Scand J Thorac Cardiovasc Surg 1980; 14: 301–5
Tonnesen E, Wanscher M, Hohndorf K, et al. Effect of methylprednisolone on the cytokine response in patients undergoing lung surgery. Acta Anaesthesiol Scand 1993; 37: 410–4
Schulze S, Moller IW, Bang U, et al. Effect of combined prednisolone, epidural analgesia and indomethacin on pain, systemic response and convalescence after cholecystectomy. Acta Chir Scand 1990; 156: 203–9
Høgevold HE, Aasen AO, Kierulf P, et al. High doses of corticosteroids in total hip replacement. Effects on components of coagulation, fibrinolytic, plasma kallikrein-kinin and complement systems. Acta Chir Scand 1989; 155: 247–50
Hammerschmidt DE, White JG, Craddock PR, et al. Corticosteroids inhibit complement-induced granulocyte aggregation. A possible mechanism for their efficacy in shock states. J Clin Invest 1979; 63: 798–803
Barber AE, Coyle SM, Fischer E, et al. Influence of hypercortisolemia on soluble tumor necrosis factor receptor II and interleukin-1 receptor antagonist responses to endotoxin in human beings. Surgery 1995; 118: 406–11
Moore PK, Hoult JR. Anti-inflammatory steroids reduce tissue PG synthetase activity and enhance PG breakdown. Nature 1980; 288: 269–70
Korman B, McKay RJ. Steroids and postoperative analgesia. Anaesth Intens Care 1985; 13: 395–8
Neugebauer E, Dietrich A, Bouillon B, et al. Steroids in trauma patients-right or wrong? A qualitative meta-analysis of clinical studies. Theor Surg 1990; 5: 44–53
Beckmann J. Basic aspects of risk-benefit analysis. Semin Thromb Hemost 1999; 25: 89–95
Edwards R, Wiholm BE, Martinez C. Concepts in risk-benefit assessment. A simple merit analysis of a medicine? Drug Saf 1996; 15: 1–7
Krantz T, Wolff C, Hjortso NC, et al. Assessment of early postoperative convalescence by a simple scoring system [in Danish]. Ugeskr Laeger 1990; 152: 1168–70
Bigler D, Jonsson T, Olsen J, et al. The effect of preoperative methylprednisolone on pulmonary function and pain after lung operations. J Thorac Cardiovasc Surg 1996; 112: 142–5
Komori K, Ishida M, Matsumoto T, et al. Cytokine patterns and the effects of a preoperative steroid treatment in the patients with abdominal aortic aneurysms. Int Angiol 1999; 18: 193–7
Launo C, Palermo S, Gobbi GC, et al. Methylprednisolone sodium succinate versus placebo in the prevention of respiratory complications after thoracic surgery [In Italian]. Minerva Anestesiol 1990; 56: 219–23
Nagelschmidt M, Fu ZX, Saad S, et al. Preoperative high dose methylprednisolone improves patients outcome after abdominal surgery. Eur J Surg 1999; 165: 971–8
Schulze S, Andersen J, Overgaard H, et al. Effect of prednisolone on the systemic response and wound healing after colonic surgery. Arch Surg 1997; 132: 129–35
Sumida M, Inaba H, Isawa E, et al. Prevention by methylprednisolone of increased circulating tumor necrosis factor-alpha levels and lung injury associated with systemic inflammatory response syndrome due to intraperitoneal hyperthermia. Anesth Analg 1999; 88: 771–6
Takeda S, Ogawa R, Nakanishi K, et al. The effect of preoperative high dose methylprednisolone in attenuating the metabolic response after oesophageal resection. Eur J Surg 1997; 163: 511–7
Zotti GC, Salzano de Luna F, Caiazza A, et al. Prevention of pulmonary complications by 6-methylprednisolone in major abdominal surgery. Ital J Surg Sci 1988; 18: 369–75
Chaney MA, Nikolov MP, Blakeman B, et al. Pulmonary effects of methylprednisolone in patients undergoing coronary artery bypass grafting and early tracheal extubation. Anesth Analg 1998; 87: 27–33
Chaney MA, Nikolov MP, Blakeman BP, et al. Hemodynamic effects of methylprednisolone in patients undergoing cardiac operation and early extubation. Ann Thorac Surg 1999; 67: 1006–11
Engelman RM, Rousou JA, Flack JE, 3rd, et al. Influence of steroids on complement and cytokine generation after cardiopulmonary bypass. Ann Thorac Surg 1995; 60: 801–4
Fecht DC, Magovern GJ, Park SB, et al. Beneficial effects of methylprednisolone in patients on cardiopulmonary bypass. Circ Shock 1978; 5: 415–22
Niazi Z, Flodin P, Joyce L, et al. Effects of glucocorticosteroids in patients undergoing coronary artery bypass surgery. Chest 1979; 76: 262–8
Tassani P, Richter JA, Barankay A, et al. Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures? J Cardiothorac Vasc Anesth 1999; 13: 165–72
Otani K, Abe H, Kadoya S, et al. Beneficial effect of methylprednisolone sodium succinate in the treatment of acute spinal cord injury [In Japanese]. Spine and Spinal Cord 1994; 7: 633–47
Otani K. Treatment effect of methylprednisolone sodium succinate in acute cervical spinal cord injury [in Japanese]. J Jpn Med Soc Parapl 1995; 8: 80–1
Petitjean ME, Pointillart V, Dixmerias F, et al. Pharmacological therapy of spinal cord injury at the acute phase [In French]. Ann Fr Anesth Reanim 1998; 17: 114–22
Pointillart V, Petitjean ME, Wiart L, et al. Pharmacological therapy of spinal cord injury during the acute phase. Spinal Cord 2000; 38: 71–6
Pettersson K, Toolanen G. High-dose methylprednisolone prevents extensive sick leave after whiplash injury. A prospective, randomized, double-blind study. Spine 1998; 23: 984–9
Høgevold HE, Hoiseth A, Reikerås O. Effect of high-dose corticosteroids on the incidence of deep vein thrombosis after total hip replacement. Arch Orthop Trauma Surg 1991; 111: 29–31
Høgevold HE, Mundal HH, Norman N, et al. Platelet release reaction and plasma catecholamines during total hip replacement. No effects of high doses of corticosteroids. Thromb Res 1990; 57: 21–9
Gammer W, Bengtson A, Heideman M. Inhibition of complement activation by high-dose corticosteroids in total hip arthroplasty. Clin Orthop 1988; 236: 205–9
Andersen LW, Baek L, Thomsen BS, et al. Effect of methylprednisolone on endotoxemia and complement activation during cardiac surgery. J Cardiothorac Anesth 1989; 3: 544–9
Jansen NJ, van Oeveren W, van Vliet M, et al. The role of different types of corticosteroids on the inflammatory mediators in cardiopulmonary bypass. Eur J Cardiothorac Surg 1991; 5: 211–7
Mayumi H, Zhang QW, Nakashima A, et al. Synergistic immuno-suppression caused by high-dose methylprednisolone and cardiopulmonary bypass. Ann Thorac Surg 1997; 63: 129–37
Morton JR, Hiebert CA, Lutes CA, et al. Effect of methylprednisolone on myocardial preservation during coronary artery surgery. Am J Surg 1976; 131: 419–22
Toft P, Christiansen K, Tonnesen E, et al. Effect of methylprednisolone on the oxidative burst activity, adhesion molecules and clinical outcome following open heart surgery. Scand Cardiovasc J 1997; 31: 283–8
Toledo-Pereyra LH, Lin CY, Kundler H, et al. Steroids in heart surgery: a clinical double-blind and randomized study. Am Surg 1980; 46: 155–60
Rao G, King J, Ford W, et al. The effects of methylprednisolone on the complications of coronary artery surgery. Vasc Surg 1977; 11: 1–7
Wan S, LeClerc JL, Schmartz D, et al. Hepatic release of interleukin-10 during cardiopulmonary bypass in steroid-pretreated patients. Am Heart J 1997; 133: 335–9
Wan S, LeClerc JL, Huynh CH, et al. Does steroid pretreatment increase endotoxin release during clinical cardiopulmonary bypass? J Thorac Cardiovasc Surg 1999; 117: 1004–8
Alho A, Saikku K, Eerola P, et al. Corticosteroids in patients with a high risk of fat embolism syndrome. Surg Gynecol Obstet 1978; 147: 358–62
Lepistö P, Avikainen V, Alho A, et al. Fat embolism in severely injured patients. Ann Chir Gynaecol Fenn 1975; 64: 198–202
Lindeque BGP, Schoeman HS, Dommisse GF, et al. Fat embolism and the fat embolism syndrome. A double-blind therapeutic study. J Bone Joint Surg Br 1987; 69: 128–31
Schonfeld SA, Ploysongsang Y, DiLisio R, et al. Fat embolism prophylaxis with corticosteroids. Aprospective study in high-risk patients. Ann Intern Med 1983; 99: 438–43
Stoltenberg JJ, Gustilo RB. The use of methylprednisolone and hypertonic glucose in the prophylaxis of fat embolism syndrome. Clin Orthop 1979; 143: 211–21
Svennevig JL, Bugge-Asperheim B, Vaage J, et al. Corticosteroids in the treatment of blunt injury of the chest. Injury 1984; 16: 80–4
Svennevig JL, Bugge-Asperheim B, Geiran O, et al. High-dose corticosteroids in thoracic trauma. Acta Chir Scand Suppl 1985; 526: 110–9
Svennevig JL, Bugge-Asperheim B, Birkeland S, et al. Efficacy of steroids in the treatment of lung contusion. Acta Chir Scand Suppl 1980; 499: 87–92
Mikawa K, Ikegaki J, Maekawa N, et al. Perioperative effect of methylprednisolone given during lung surgery on plasma concentrations of C3a and C5a. Scand J Thorac Cardiovasc Surg 1990; 24: 229–33
Edfeldt H, Thomson D. Early hemodynamic and respiratory changes following tourniquet release - influence of large doses of methylprednisolone. Acta Chir Scand Suppl 1980; 499: 45–55
Boscoe MJ, Yewdall VM, Thompson MA, et al. Complement activation during cardiopulmonary bypass: quantitative study of effects of methylprednisolone and pulsatile flow. BMJ 1983; 287: 1747–50
Diego RP, Mihalakakos PJ, Hexum TD, et al. Methylprednisolone and full-dose aprotinin reduce reperfusion injury after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1997; 11: 29–31
Enderby DH, Boylett A, Parker DJ. Methyl prednisolone and lung function after cardiopulmonary bypass. Thorax 1979; 34: 720–5
Ferries LH, Marx Jr JJ, Ray III JF. The effect of methylprednisolone on complement activation during cardiopulmonary bypass. J Extracorp Technol 1984; 16: 83–8
Fosse E, Mollnes TE, Østerud A, et al. Effects of methylprednisolone on complement activation and leukocyte counts during cardiopulmonary bypass. Scand J Thorac Cardiovasc Surg 1987; 21: 255–61
Hill GE, Alonso A, Thiele GM, et al. Glucocorticoids blunt neutrophil CD11b surface glycoprotein upregulation during cardiopulmonary bypass in humans. Anesth Analg 1994; 79: 23–7
Hill GE, Alonso A, Spurzem JR, et al. Aprotinin and methylprednisolone equally blunt cardiopulmonary bypass-induced inflammation in humans. J Thorac Cardiovasc Surg 1995; 110: 1658–62
Jorens PG, De Jongh R, De Backer W, et al. Interleukin-8 production in patients undergoing cardiopulmonary bypass. The influence of pretreatment with methylprednisolone. Am Rev Respir Dis 1993; 148: 890–5
Karlstad MD, Patteson SK, Guszcza JA, et al. Methylprednisolone does not influence endotoxin translocation during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1993; 7: 23–7
Kawamura T, Inada K, Nara N, et al. Influence of methylprednisolone on cytokine balance during cardiac surgery. Crit Care Med 1999; 27: 545–8
Kawamura T, Inada K, Okada H, et al. Methylprednisolone inhibits increase of interleukin 8 and 6 during open heart surgery. Can J Anaesth 1995; 42: 399–403
Kobayashi N. The circulatory and respiratory effects of methylprednisolone associated with catecholamine undergoing open heart surgery [In Japanese]. Tokyo Joshi Ikadaigaku Zasshi [Journal of Tokyo Womens Medical College] 1996; 66: 1–10
Loubser PG, Yawn D. Effects of methylprednisolone on complement activation during cardiopulmonary bypass and following protamine administration [abstract]. Anesthesiology 1994; 81: A173
Loubser PG. Effect of methylprednisolone on complement activation during heparin neutralization. J Cardiovasc Pharmacol 1997; 29: 23–7
Tabardel Y, Duchateau J, Schmartz D, et al. Corticosteroids increase blood interleukin-10 levels during cardiopulmonary bypass in men. Surgery 1996; 119: 76–80
Thompson MA, Broadbent MP. Methylprednisolone prior to cardiopulmonary bypass. Anaesthesia 1980; 35: 345–53
Thompson MA, Broadbent MP, English J. Plasma levels of methylprednisolone following administration during cardiac surgery. Anaesthesia 1982; 37: 405–7
Deeks J, Bradburn M, Localio R, et al. Much ado about nothing: statistical methods for meta-analysis with rare events [abstract]. 2nd Symposium on Systematic Reviews. 1999 Jan 8-9; Oxford, 31
Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995; 310: 452–4
Dernek S, Tünerir B, Sevin B, et al. The effects of methylprednisolone on complement, immunoglobulins and pulmonary neutrophil sequestration during cardiopulmonary bypass. Cardiovasc Surg 1999; 7: 414–8
Shimada M, Saitoh A, Kano T, et al. The effect of a perioperative steroid pulse on surgical stress in hepatic resection. Int Surg 1996; 81: 49–51
Teoh KH, Bradley CA, Gauldie J, et al. Steroid inhibition of cytokine-mediated vasodilation after warm heart surgery. Circulation 1995; 92 Supple. 2: S347–S353
van der Merwe CJ, Louw AF, Welthagen D, et al. Adult respiratory distress syndrome in cases of severe trauma-the prophylactic value of methylprednisolone sodium succinate. S Afr Med J 1985; 67: 279–84
Lee CW, Chae JK, Lim HY, et al. Prospective randomized trial of corticosteroids for the prevention of restenosis after intracoronary stent implantation. Am Heart J 1999; 138: 60–3
Pepine CJ, Hirshfeld JW, Macdonald RG, et al. Acontrolled trial of corticosteroids to prevent restenosis after coronary angioplasty. M-HEART Group. Circulation 1990; 81: 1753–61
Flood TR, McManners J, El-Attar A, et al. Randomized prospective study of the influence of steroids on postoperative eyeopening after exploration of the orbital floor. Br J Oral Maxillofac Surg 1999; 37: 312–5
Holland CS. The influence of methylprednislone on post-operative swelling following oral surgery. Br J Oral Maxillofac Surg 1987; 25: 293–9
Butler J, Pathi VL, Paton RD, et al. Acute-phase responses to cardiopulmonary bypass in children weighing less than 10 kilograms. Ann Thorac Surg 1996; 62: 538–42
Westfall SH, Stephens C, Kesler K, et al. Complement activation during prolonged extracorporeal membrane oxygenation. Surgery 1991; 110: 887–91
Kallenbach J, Lewis M, Zaltzman M, et al. ’Low-dose’ corticosteroid prophylaxis against fat embolism. J Trauma 1987; 27: 1173–6
Matsutani T, Onda M, Sasajima K, et al. Glucocorticoid attenuates a decrease of antithrombin III following major surgery. J Surg Res 1998; 79: 158–63
Rendina EA, Venuta F, Ricci C. Effects of low-dose steroids on bronchial healing after sleeve resection. A clinical study. J Thorac Cardiovasc Surg 1992; 104: 888–91
Peillon D, Dubost J, Roche C, et al. Effect of corticosteroids and haemodilution on postoperative inflammation after maxillofacial surgery. Ann Fr Anesth Reanim 1996; 15: 157–61
Owsley JQ, Weibel TJ, Adams WA. Does steroid medication reduce facial edema following face lift surgery? A prospective, randomized study of 30 consecutive patients. Plast Reconstr Surg 1996; 98: 1–6
Marion DW, Jannetta PJ. Use of perioperative steroids with microvascular decompression operations. Neurosurgery 1988; 22: 353–7
Williams PM, Strome M, Eliachar I, et al. Impact of steroids on recovery after uvulopalatopharyngoplasty. Laryngoscope 1999; 109: 1941–6
Bouillon B, Kramer M, Schafer U, et al. High dose corticosteroids in patients with multiple trauma [abstract]. Shock 1996; 5Suppl. 2: S45
Muñoz C, Conejero R, Caturla J, et al. Inhibition of cytokine production in cardiopulmonary bypass [abstract]. Clin Intens Care 1992; 3 Suppl.: S52
Schulze S, Sommer P, Bigler D, et al. Effect of combined prednisolone, epidural analgesia, and indomethacin on the systemic response after colonic surgery. Arch Surg 1992; 127: 325–31
Vallejo JL, Gimenez-Fernandez R, Mainer JL, et al. Análisis clínico del efecto protector de la metil-prednisolona sobre el corazón en paro anoxico (estudio randomizado). Rev Esp Cardiol 1977; 30: 705–9
Fu ZX, Nagelschmidt M, Saad S, et al. Improved outcome by preoperative administration of methylprednisolone before large abdominal surgery interventions-a prospective double-blind study [in German]. Langenbecks Arch Chir Suppl Kongressbd 1997; 114: 663–6
Derendorf H, Mollmann H, Krieg M, et al. Pharmacodynamics of methylprednisolone phosphate after single intravenous administration to healthy volunteers. Pharm Res 1991; 8: 263–8
Novak E, Stubbs SS, Seckman CE, et al. Effects of a single large intravenous dose of methylprednisolone sodium succinate. Clin Pharmacol Ther 1970; 11: 711–7
Eypasch E, Lefering R, Kum CK, et al. Probability of adverse events that have not yet occurred: a statistical reminder. BMJ 1995; 311: 619–20
Conn HO, Blitzer BL. Nonassociation of adrenocorticosteroid therapy and peptic ulcer. N Engl J Med 1976; 294: 473–9
McIntyre PB, Berkey CS, King SM, et al. Dexamethasone as adjunctive therapy in bacterial meningitis. Ameta-analysis of randomized clinical trials since 1988. JAMA 1997; 278: 925–31
Dumouchel W. Meta-analysis for dose-response models. Stat Med 1995; 14: 679–85
DeMaria EJ, Reichman W, Kenney PR, et al. Septic complications of corticosteroid administration after central nervous system trauma. Ann Surg 1985; 202: 248–52
Galandiuk S, Raque G, Appel S, et al. The two-edged sword of large-dose steroids for spinal cord trauma. Ann Surg 1993; 218: 419–27
Gerndt SJ, Rodriguez JL, Pawlik JW, et al. Consequences of high-dose steroid therapy for acute spinal cord injury. J Trauma 1997; 42: 279–84
Kunz R, Oxman AD. The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials. BMJ 1998; 317: 1185–90
Bocanegra TS, Castañeda MO, Espinoza LR, et al. Sudden death after methylprednisolone pulse therapy [letter]. Ann Intern Med 1981; 95: 122
Moses RE, McCormick A, Nickey W. Fatal arrhythmia after pulse methylprednisolone therapy. Ann Intern Med 1981; 95: 781–2
Guillen EL, Ruiz AM, Bugallo JB. Hypotension, bradycardia, and asystole after high-dose intravenous methylprednisolone in a monitored patient [letter]. Am J Kidney Dis 1998; 32: E4
Tvede N, Nielsen LP, Andersen V. Bradycardia after high-dose intravenous methylprednisolone therapy. Scand J Rheumatol 1986; 15: 302–4
Lewis DA, Smith RE. Steroid-induced psychiatric syndromes. A report of 14 cases and a review of the literature. J Affect Disord 1983; 5: 319–32
Olsen R, Lindberg C, Anderson O. Centrolobular liver cell necrosis, myocardial infarction, and hyperamylasaemia after high dose corticosteroids [letter]. BMJ 1994; 308: 454
Smith RS, Warren DJ. Effects of high-dose intravenous methylprednisolone on circulation in humans. Transplantation 1983; 35: 349–51
Schonwald S. Methylprednisolone anaphylaxis. Am J Emerg Med 1999; 17: 583–5
Schulz KF, Chalmers I, Hayes RH, et al. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995; 273: 408–12
Plihal W, Krug R, Pietrowsky R, et al. Corticosteroid receptor mediated effects on mood in humans. Psychoneuroendo-crinology 1996; 21: 515–23
Patten SB, Neutel SI. Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management. Drug Saf 2000; 22: 111–22
Felson DT, Anderson JJ. Across-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone. Lancet 1987; I: 902–6
Acknowledgments
We would like to thank Professor Michael B. Bracken, from Yale University, New Haven, Connecticut, US., and Mrs Kazuko Yatsushiro, from Tübingen, Germany, for their help in translating Japanese and French articles.
We have been supported by the Deutsche Forschungs-gemeinschaft (Grant No. SA-862-1/1) and the Koln Fortune Programme/Faculty of Medicine, University of Cologne.
Portions of this article have been presented at the Congress of the German Society for Surgery, Berlin, 2000.
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Sauerland, S., Nagelschmidt, M., Mallmann, P. et al. Risks and Benefits of Preoperative High Dose Methylprednisolone in Surgical Patients. Drug-Safety 23, 449–461 (2000). https://doi.org/10.2165/00002018-200023050-00007
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DOI: https://doi.org/10.2165/00002018-200023050-00007