EFFECT OF DEXAMETHASONE VERSUS PLACEBO FOR IMPROVED RECOVERY IN PATIENTS UNDERGOING ANAESTHETIC INTERVENTIONS FOR GENERAL SURGICAL PROCEDURES

Sara Haider Malik, Nighat Begum, Allah Ditta Ashfaq, Huma Saleem, Muhammad Tariq Shah, Muhammad Hanif, Tariq Abbasi

Abstract


Background: Endotracheal intubation is one of the basic prerequisites of general anaesthesia. Recovery of patients is delayed due to the development of post-operative nausea, vomiting, sore throat and shivering. This study was conducted to determine role of dexamethasone for improved recovery of patients. Methods: This randomized controlled trial was performed in the Department of Anaesthesia, Ayub Teaching Hospital, Abbottabad from June to November 2018. One hundred and twenty-two consenting patients of both genders, aged between 18–60 years, American Society of Anaesthesiologists (ASA) I and II, scheduled for general surgeries of 60–180 minutes duration under general anaesthesia were included. Patients with long duration surgeries, anticipated difficult airways, nasogastric tube in situ, upper respiratory tract infections, on steroid therapy and critically ill and emergency surgeries were excluded. They were randomly allocated into two groups by lottery method as dexamethasone (group A, n=61) or Placebo (group B, n=61). Post-operative nausea, vomiting, sore throat was observed at 2, 12 and 24 hours, shivering was observed at 2 hours only and patient satisfaction at 24 hours post-operatively. Results: Group A patients had statistically proven better outcomes at 2, 12 and 24 hours for post-operative sore throat, nausea and vomiting, shivering was controlled in 24.5% p-value (0.006). Patient satisfaction was found in 83.6% of group A patients. Conclusion: Thus, dexamethasone is effective drug for prevention of postoperative nausea, vomiting, sore throat and shivering in general surgical procedures thus improving patient satisfaction and their early discharge.

Keywords: Dexamethasone; sore throat; nausea; vomiting; shivering; patient satisfaction


References


Sumathi PA, Shenoy T, Ambareesha M, Krishna HM. Controlled comparison between betamethasone gel and lidocaine jelly applied over tracheal tube to reduce postoperative sore throat, cough, and hoarseness of voice. Br J Anaesth 2008;100(2):215–8.

Thomas S, Beevi S. Dexamethasone reduces the severity of postoperative sore throat. Can J Anaesth 2007;54(11):897–901.

De Oliveira G, Ahmad S, Fitzgerald P, Marcus R, Altman C, Panjwani A, et al. Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery. Br J Anaes 2011;107(3):362–71.

Gornall BF, Myles PS, Smith CL, Burke JA, Leslie K, Pereira MJ, et al. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth 2013;111(2):161–9.

Sherif L, Hegde R, Mariswami M, Ollapally A. Validation of the Apfel scoring system for identification of High-risk patients for PONV. Karnataka Anaesth J 2015;1(3):115–7.

Kumar V, Abbas AK, Fausto N, Aste JC. Robbins and Cotran Pathologic Basic of Disease. 8th ed. Chapter 2, Acute and chronic inflammation. Philadelphia: Saunders Elsevier; 2010.

Bagchi D, Mandal MC, Das S, Sahoo T, Basu SR, Sarkar S. Efficacy of intravenous dexamethasone to reduce incidence of postoperative sore throat: A prospective randomized controlled trial. J Anaesthesiol Clin Pharmacol 2012;28(4):477–80.

Yared JP, Starr NJ, Hoffmann-Hogg L, Bashour CA, Insler SR, O'Connor M, et al. Dexamethasone decreases the incidence of shivering after cardiac surgery: a randomized, double-blind, placebo-controlled study. Anesth Analg 1998;87(4):795–9.

Murphy GS, Sherwani SS, Szokol JW, Avram MJ, Greenberg SB, Patel KM, et al. Small-Dose Dexamethasone Improves Quality of Recovery Scores After Elective Cardiac Surgery: A Randomized, Double-Blind, Placebo-Controlled Study. J Cardiothorac Vasc Anesth 2011;25(6):950–96.

Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, et al. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 2016;40(9):2065–83.

Wang JJ, Ho ST, Lee SC, Liu YC, Ho CM. The Use of Dexamethasone for Preventing Postoperative Nausea and Vomiting in Females Undergoing Thyroidectomy: A Dose-Ranging Study. Anesth Analg 2000;91(6):1404–7.

Wang JJ, Ho ST, Tzeng JI, Tang CS. The Effect of Timing of Dexamethasone Administration on Its Efficacy as a Prophylactic Antiemetic for Postoperative Nausea and Vomiting. Anesth Analg 2000;91(1):136–9.

Henzi I, Walder B, Tramèr MR. Dexamethasone for the Prevention of Postoperative Nausea and Vomiting: A Quantitative Systematic Review. Anesth Analg 2000;90(1):186–94.

Karanicolas PJ, Smith SE, Kanbur B, Davies E, Guyatt GH. The Impact of Prophylactic Dexamethasone on Nausea and Vomiting After Laparoscopic Cholecystectomy: a systematic review and meta-analysis. Ann Surg 2008;248(5):751–62.

Entezariasl M, Isazadehfar K. Dexamethasone for prevention of postoperative shivering: a randomized double-blind comparison with pethidine. Int J Prev Med 2013;4(7):818–24.

Sun L, Guo R, Sun L. Dexamethasone for preventing postoperative sore throat: a meta-analysis of randomized controlled trials. Ir J Med Sci 2014;183(4):593–600.

De Oliveira G, Almeida M, Benzon H, McCarthy R. Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain. Anesthesiology 2011;115(3):575–88.

Liu K, Hsu CC, Chia YY. Effect of dexamethasone on postoperative emesis and pain. Br J Anaesth 1998;80(1):85–6.


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