Acta Anaesthesiol Scand. 2022 Feb 6. doi: 10.1111/aas.14040. Online ahead of print.
ABSTRACT
INTRODUCTION: Existing multimodal pathways for patients undergoing acute high-risk abdominal surgery for intestinal obstruction (IO) and perforated viscus (PV) has focused on rescue in the immediate perioperative period. However, there is little focus on the peri-operative pathophysiology of recovery in this patient group, as done to develop enhanced recovery pathways in elective care. Acute inflammation is a main driver of the perioperative pathophysiology leading to adverse outcomes. Pre-operative high-dose glucocorticoids provide reduction in the inflammatory response after surgery, effective pain relief in several major surgical procedures, as well as reducing fatigue and improving endothelial dysfunction.
AIM: To evaluate the effect of high-dose glucocorticoid on inflammatory response, fluid distribution and recovery after acute high-risk abdominal surgery in patients with IO and PV.
METHODS: AHA STEROID trial is a sponsor-initiated single center, randomized, double-blind placebo-controlled trial, assessing preoperative high-dose Dexamethasone (1mg/kg) versus placebo (normal saline) in patients undergoing emergency high-risk abdominal surgery. We plan to enroll 120 patients. Primary outcome is reduction in C-reactive protein on postoperative day one as a marker of successful attenuation of acute stress response. Secondary outcomes include perioperative change in endothelial and other inflammatory markers, fluid distribution, pulmonary function, pain, fatigue, and mobilization. The statistical plan is outlined in the protocol.
DISCUSSION: The AHA STEROID trial will provide important evidence to guide the potential use of high-dose glucocorticoids in emergency high-risk abdominal surgery, with respect to different pathophysiologies.
PMID:35124808 | DOI:10.1111/aas.14040
