Preoperative Dexamethasone Research Articles

Efficacy of Submucosal versus Pterygomandibular Dexamethasone Injection in Surgical Extraction of the Impacted Lower Third Molar

Objectives: This study aimed to evaluate the efficacy and postoperative complications of preoperative submucosal dexamethasone injection compared to preoperative dexamethasone injection into the pterygomandibular space for surgical extraction of the impacted lower third molar. Study design and setting: This was a quasi-experimental, cross-sectional study conducted at the Department of Oral and Maxillofacial Surgery, Dow International Dental College, Dow University of Health Sciences, Karachi, from April to July 2021. Methodology: The study sample consisted of 72 patients who reported surgical extraction of their lower wisdom teeth and consented to participate in this study. The patients were randomly divided into the submucosal injection group (SM) and the pterygomandibular space (PM) group. The injection time was recorded on the second and seventh postoperative days. Results: No significant differences in the duration of the intervention were observed between the two groups (23.08 min in PM, 23.07 min in SM). The postoperative facial swelling was significantly reduced transversely (ear lobe to the angle of the mouth) in both groups compared to their respective baselines on the first postoperative day. On the secondpostoperative day, significant changes were observed in the submucosal group in postoperative swelling. Conclusions: Using intraoral dexamethasone injections in third molar surgery significantly reduces conventional complications of surgery while avoiding the systemic side effects of steroids. Dexamethasone should be used regardless of the administration site when warranted, with less apprehension than is common in dentistry

Investigation of the Effect of Local and Systemic Preoperative Dexamethasone Application on Bone Tissue Healing in Mandibular Bone Defects.

The aim of this study was to investigate the effect of locally and systemically delivered single-dose corticosteroid injections on bone tissue. A total of 84 Wistar albino rats were divided into 2 groups as local and systemic injection groups, and 2 groups as control and experiment among themselves. Before the procedure, dexamethasone was given to the experimental group and physiological saline was given to the control group. A defect was created in the jawbone. It was sacrificed on the third, seventh, and 40th days. The mandible bones of the sacrificed rats were removed and the healing of the bone tissue was examined histopathologically. No significant difference was observed in the tissue sections of the subjects sacrificed after 40 days. However, the increase in fibroblastic connective tissue and the number of osteoblasts were less in the experimental local groups that were sacrificed after 7 days compared with the control groups (P=0.040 and 0.041). Again, it was determined that there was a statistically significant decrease in the experimental local group compared with the experimental systemic group (P=0.040 and 0.004). It can be said that single-dose corticosteroid applications cause a delay in bone healing in the early period.

Efficacy of preoperative single-dose dexamethasone in preventing postoperative pulmonary complications following minimally invasive esophagectomy: a retrospective propensity score-matched study

BackgroundThe study was performed to investigate the efficacy and safety of preoperative dexamethasone (DXM) in preventing postoperative pulmonary complications (PPCs) after minimally invasive esophagectomy (MIE).MethodsPatients who underwent total MIE with two-field lymph node dissection from February 2018 to February 2023 were included in this study. Patients who were given either 5 mg or 10 mg DXM as preoperative prophylactic medication before induction of general anesthesia were assigned to the DXM group, while patients who did not receive DXM were assigned to the control group. Preoperative evaluations, intraoperative data, and occurrence of postoperative complications were analyzed. The primary outcome was the incidence of PPCs occurring by day 7 after surgery.ResultsIn total, 659 patients were included in the study; 453 patients received preoperative DXM, while 206 patients did not. Propensity score-matched analysis created a matched cohort of 366 patients, with 183 patients each in the DXM and control groups. A total of 24.6% of patients in the DXM group and 30.6% of patients in the control group had PPCs (P = 0.198). The incidence of respiratory failure was significantly lower in the DXM group than in the control group (1.1% vs 5.5%, P = 0.019). Fewer patients were re-intubated during their hospital stay in the DXM group than in the control group (1.1% vs 5.5%, P = 0.019).ConclusionsPreoperative DXM before induction of anesthesia did not reduce overall PPC development after MIE. Nevertheless, the occurrence of early respiratory failure and the incidence of re-intubation during hospitalization were decreased.Trial registrationChinese Clinical Trial Registry (No. ChiCTR2300071674; Date of registration, 22/05/2023)

The Impact of Preoperative Dexamethasone Administration on Quality of Recovery Following Laparoscopic Sleeve Gastrectomy: A Prospective Observational Study

IntroductionRecovery from anesthesia is complex and affected by multiple factors. In patient with obesity, the increased prevalence of anxiety and depressive disorders poses a challenge in achieving optimal patient satisfaction. Therefore, strategies to enhance the quality of recovery are crucial for this population. This study aimed to investigate whether administration of dexamethasone to patients undergoing laparoscopic sleeve gastrectomy (LSG) could improve recovery outcomes.MethodsThis prospective observational study was conducted at a tertiary university hospital in Samsun, Turkey. Thirty patients who received dexamethasone prior to LSG (group D) and 30 patients who did not (group C) were included with convenience sampling method. The quality of recovery was assessed using the Quality of Recovery 40 questionnaire (QoR-40). The primary outcome measure was the QoR-40 score at 24 h postoperatively.ResultsThe dexamethasone group showed a significant improvement in QoR-40 scores (185.4 ± 6.0 vs. 172.0 ± 8.4, p < 0.001), exhibited reduced morphine consumption (11.8 ± 7.8 vs. 21.8 ± 10.9 mg, p < 0.001), opioid demand count (21.50 [9.50–49.00], p = 0.001), the number of patient used antiemetic drug (1 vs. 22, p < 0.001), and achieved earlier mobilization (3 [3–4] vs. 3 [3–4] h, p < 0.0001). However, no significant differences were observed between the two groups concerning intraoperative complications, postoperative wound infections, or time to discharge.ConclusionsIn patients undergoing laparoscopic sleeve gastrectomy, preoperative dexamethasone administration was associated with improved the recovery quality after discharge and reduced early postoperative need for antiemetic medications.Graphical

Preoperative dexamethasone administration in reducing the incidence of nausea and vomiting after thyroidectomy: a systematic review and meta-analysis of drug dosage.

Postoperative nausea and vomiting (PONV) are key contributors to the delay of recovery and cause patients' considerable discomfort. This study aimed to evaluate the influence of a specific dexamethasone dosage on PONV incidence, with a secondary objective of assessing its impact on postoperative pain in patients undergoing thyroid surgery. A meta-analysis was performed to examine the effects of preoperatively administering various doses of dexamethasone in combination with saline on PONV and pain relief in patients undergoing thyroidectomy. Relevant trials published before December 30, 2022, were searched in the PubMed, Embase, Cochrane Library, and Web of Science databases. The collected data were analyzed using RevMan 5.3 software (Cochrane), and a random-effects model or fixed-effects model was employed to conduct the meta-analysis. Our meta-analysis included 11 randomized controlled trials (RCTs) with a total of 1,544 participants. The results suggested that administering dexamethasone at a dosage of 8-10 mg can reduce the incidence of PONV in patients after thyroid surgery [odds ratio (OR) 0.27; 95% CI: 0.15-0.50; I2=82%; P<0.0001]. Additionally, administering dexamethasone at a dosage of 8-10 mg was found to be significantly more effective in reducing the incidence of PONV than was a dosage of 4-5 mg (OR 0.39; 95% CI: 0.19-0.80; I2=29%; P=0.01). The study also revealed that administering dexamethasone at a dosage of 8-10 mg can significantly reduce pain in patients undergoing thyroidectomy [mean difference (MD): -1.19; 95% CI: -1.97 to -0.41; I2=96%; P=0.003]. However, administering dexamethasone at a dosage of 4-5 mg did not significantly reduce pain (MD: -0.27; 95% CI: -1.00 to 0.45; I2=0%; P=0.46) according to the subgroup analysis. Our study found that the intervention of administering dexamethasone did not have a significant impact on the consumption of analgesic drugs (MD: -0.19; 95% CI: -0.45 to 0.08; I2=62%; P=0.16). A preoperative single dose of 8-10 mg of dexamethasone can significantly reduce PONV and the requirement for additional antiemetic medications, as well as alleviate postoperative pain after thyroidectomy. However, more RCTs should be conducted to determine the effects of varied dexamethasone dosages, particularly 4-5 mg, on the incidence of PONV and pain.

Role of preoperative dexamethasone nebulization versus ketamine nebulization in reducing complications of nasogastric tube after laparoscopic surgery

Background &amp; objective: Nasogastric (NG) tube insertion is a frequently performed medical procedure. Most of the time, the oropharyngeal discomfort is usually underestimated, and insertions are carried out with just regular lubricant jelly and no additional painkillers, which results in less-than-ideal pain management. We compared the effectiveness of preemptive use of nebulized ketamine and dexamethasone in preventing post-operative sore throat following NG tube insertion in laparoscopic surgery.&#x0D; Methods: This prospective randomized double-blind controlled study was carried on 108 patients of both sexes with ASA physical status I-II. aged 20-60 years, undergoing laparoscopic abdominal surgeries under general anesthesia. Patients were randomized into 3 equal groups. Group D received a dose of 8 mg nebulized dexamethasone. Group K received 50 mg nebulized ketamine. Group S received 5 ml of nebulized saline. NG tube was passed after induction of general anesthesia. Postoperative sore throat was enquired from the patients at full recovery (zero hour), then at 2, 8, 12 and 24 h. Computer software (SPSS 15.0.1. for Windows; SPSS Inc, Chicago, IL, 2001) was used for data analysis. Non-parametric quantitative data, median, range, percentages, and numbers are given for qualitative data. The appropriate analysis was conducted in line with the data obtained. P &lt; 0.05 was regarded as significant.&#x0D; Results: The incidence of postoperative sore throat (POST) was lower with both nebulized dexamethasone and nebulized ketamine compared with nebulized saline; and significantly lower with dexamethasone compared with ketamine at 0 h (P &lt; 0.001), 2 h (P &lt; 0.001), 8 h (P &lt; 0.001), 12 h (P &lt; 0.001), and 24 h (P &lt; 0.001).&#x0D; Conclusion: The current study revealed that preoperative nebulized dexamethasone was more effective than nebulized ketamine in reducing postoperative sore throat.&#x0D; Abbreviations: NG- Nasogastric; NMDA- N-Methyl-D-Aspartate; PONV- Postoperative Nausea and Vomiting; POST- Postoperative Sore Throat; VAS- Visual Analogue Scale&#x0D; Key words: Nebulization; Dexamethasone; Ketamine; Laparoscopic Surgery; Nasogastric Tube&#x0D; Citation: Zakaria MM, Mohammed Aboulella SK, Hassanein SMK, Elsayed El Hennawy AM, Salah El Din Shabana TS. Role of preoperative dexamethasone nebulization versus ketamine nebulization in reducing complications of nasogastric tube after laparoscopic surgery. Anaesth. pain intensive care 2024;28(1):62-67.&#x0D; DOI: 10.35975/apic.v28i1.2275&#x0D; Received: 22 July, 2023; Reviewed: 04 October 2023; Accepted: 30 October 2023

The immunological landscape of peripheral blood in glioblastoma patients and immunological consequences of age and dexamethasone treatment.

Glioblastomas manipulate the immune system both locally and systemically, yet, glioblastoma-associated changes in peripheral blood immune composition are poorly studied. Age and dexamethasone administration in glioblastoma patients have been hypothesized to limit the effectiveness of immunotherapy, but their effects remain unclear. We compared peripheral blood immune composition in patients with different types of brain tumor to determine the influence of age, dexamethasone treatment, and tumor volume. High-dimensional mass cytometry was used to characterise peripheral blood mononuclear cells of 169 patients with glioblastoma, lower grade astrocytoma, metastases and meningioma. We used blood from medically-refractory epilepsy patients and healthy controls as control groups. Immune phenotyping was performed using FlowSOM and t-SNE analysis in R followed by supervised annotation of the resulting clusters. We conducted multiple linear regression analysis between intracranial pathology and cell type abundance, corrected for clinical variables. We tested correlations between cell type abundance and survival with Cox-regression analyses. Glioblastoma patients had significantly fewer naive CD4+ T cells, but higher percentages of mature NK cells than controls. Decreases of naive CD8+ T cells and alternative monocytes and an increase of memory B cells in glioblastoma patients were influenced by age and dexamethasone treatment, and only memory B cells by tumor volume. Progression free survival was associated with percentages of CD4+ regulatory T cells and double negative T cells. High-dimensional mass cytometry of peripheral blood in patients with different types of intracranial tumor provides insight into the relation between intracranial pathology and peripheral immune status. Wide immunosuppression associated with age and pre-operative dexamethasone treatment provide further evidence for their deleterious effects on treatment with immunotherapy.

The effect of preoperative different dexamethasone regimens on postoperative glycemic control in patients with type 2 diabetes mellitus undergoing total joint arthroplasty: a retrospective cohort study

BackgroundConcerns have been raised regarding the impact of preoperative intravenous dexamethasone on postoperative glycemic control in diabetic patients undergoing total joint arthroplasty (TJA). This study aimed to determine relationships between preoperative different dexamethasone regimens and postoperative fasting blood glucose (FBG), as well as to identify risk factors for postoperative FBG ≥ 200 mg/dl in diabetic patients undergoing TJA.MethodsThis retrospective study included 1216 diabetic patients undergoing TJA and categorized into group A (dexamethasone = 0 mg), group B (dexamethasone = 5 mg), and group C (dexamethasone = 10 mg). All dexamethasone was administered before skin incision. FBG levels were monitored until postoperative day (POD) 3. Analyses were conducted for periprosthetic joint infection (PJI) and wound complications during 90 days postoperatively. And the risk factors for postoperative FBG ≥ 200 mg/dl were identified.ResultsPreoperative dexamethasone administration resulted in a transiently higher FBG on POD 0 and POD 1 (all P < 0.001). However, no differences were observed on POD 2 (P = 0.583) and POD 3 (P = 0.131) among three groups. While preoperative dexamethasone led to an increase in postoperative mean FBG and postoperative maximum FBG (all P < 0.001), no differences were found in wound complications (P = 0.548) and PJI (P = 1.000). Increased HbA1c and preoperative high FBG, but not preoperative dexamethasone, were identified as risk factors for postoperative FBG ≥ 200 mg/dl. Preoperative HbA1c level of ≥ 7.15% was associated with an elevated risk of postoperative FBG ≥ 200 mg/dl.ConclusionsAlthough preoperative intravenous administration of 5 mg or 10 mg dexamethasone in diabetic patients showed transient effects on postoperative FBG after TJA, no differences were found in the rates of PJI and wound complications during 90 days postoperatively. Notably, patients with a preoperative HbA1c level of ≥ 7.15% and elevated preoperative FBG may encountered postoperative FBG ≥ 200 mg/dl.

Preoperative dexamethasone administration in hepatectomy of 25-min intermittent Pringle’s maneuver for hepatocellular carcinoma: protocol for a randomized controlled trial

BackgroundOur previous randomized controlled trial (RCT) have demonstrated that intermittent Pringle’s maneuver (IPM) with a 25-min ischemic interval can be applied safely and efficiently in open or laparoscopic hepatectomy in patients with hepatocellular carcinoma (HCC) patients. But prolonging the hepatic inflow blocking time will inevitably aggravate the ischemia-reperfusion injury (IRI) caused by systemic response. This RCT aims to evaluate the effect of administration of dexamethasone versus placebo before clamping the hilar pedicle on postoperative liver function, inflammatory response, and perioperative outcomes among HCC patients undergoing liver resection with 25-min hepatic inflow occlusion.Methods and analysisThis will be a randomized, dual-arm, parallel-group, double-blinded trial. All eligible and consecutive patients are coming from a regional medical center who are diagnosed with HCC and underwent radical R0/R1 resection. All participates are randomly allocated in dexamethasone group or placebo group. All surgeons, anesthesiologists, and outcome assessors will be blinded to allocation status. Primary endpoints are transaminase-based postoperative hepatic injury on seven consecutive days after surgery and assessed by their peak values as well as area under the curve (AUC) of the postoperative course of aminotransferases. Secondary endpoints are postoperative total bilirubin (TBil), coagulation function, inflammatory cytokines and their respective peaks, intraoperative blood loss, postoperative hospital stay, morbidity, and mortality. The above parameters will be compared using the corresponding statistical approach. Subgroup analysis will be performed according to the liver cirrhosis and major hepatectomy.DiscussionBased on our previous study, we will explore further the effect of glucocorticoid administration on attenuating the surgical stress response in order to follow securely 25-min hepatic inflow occlusion. Therefore, the trial protocol is reasonable and the results of the trial may be clinically significant.Trial registrationThis trial was registered on 3 December 2022, in the Chinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR2200066381. The protocol version is V1.0 (20221104).

Effect of Preoperative Corticosteroids on Postoperative Glucose Control in Total Joint Arthroplasty

BackgroundDexamethasone is a commonly used perioperative medication for the management of postoperative nausea and vomiting following total joint arthroplasty (TJA). However, concerns have been raised about its potential to cause hyperglycemia. This study aimed to investigate the impact of dexamethasone administration on glucose levels and complications in both diabetic and nondiabetic patients undergoing TJA. MethodsWe performed a retrospective review of 1928 patients who underwent primary total knee and hip arthroplasty procedures at a large tertiary medical institution. Patients were divided into 2 groups based on whether they received preoperative dexamethasone. Postoperative blood glucose values and variability were measured, and data on complications were collected. We performed statistical analysis using descriptive analysis, multivariate logistic regression models, negative binomial regression, and a subset analysis to assess the impact of dexamethasone dose on postoperative glycemic control. ResultsPreoperative dexamethasone did not significantly increase the mean glucose, fasting glucose, glucose variability, or 90-day complications in both the diabetic and nondiabetic groups. Nondiabetic patients who received dexamethasone had a significantly lower rate of intensive care unit admission (P < .01). Additionally, patients who received dexamethasone had a significantly shorter length of hospital stay compared to those who did not (P < .001). ConclusionsPreoperative dexamethasone administration is a safe and effective method for preventing postoperative nausea and vomiting in patients undergoing TJA without significant adverse effects on glucose levels, glucose variability, or infection rates in both diabetics and nondiabetics. Preoperative dexamethasone decreases postoperative length of stay.

Advancing Preoperative Strategies for Thyroidectomy in Graves' Disease: A Narrative Review.

Graves' disease is an autoimmune disorder characterized by thyroid-stimulating antibodies that can potentially lead to thyrotoxicosis, goiter, skin disease, and eye disease. Available treatment options for Graves' disease include management with antithyroid drugs (ATDs), thyroid ablation with radioactive iodine (RAI), and surgical thyroid gland removal. For individuals unable to reach a normal thyroid hormone level, promptly considering a thyroidectomy is essential. Preoperative strategies to achieve a euthyroid state prevent thyroid storms and minimize postoperative complications and are therefore crucial. While variations in professional guidance exist, this review focuses on standard medical interventions as well as compares respective guidelines set forth by the American Thyroid Association, the European Thyroid Association, the American Association of Clinical Endocrinology, and the American Association of Endocrine Surgeons. There is consensus among these organizations underscoring the importance of rendering patients euthyroid prior to surgery and the use of ATDs. Most guidelines recommend screening for vitamin D deficiency as well as endorse thyroidectomy as the preferred treatment option for hyperthyroidism with skilled surgeons. Nevertheless, discrepancies do become apparent in aspects such as potassium iodide (SSKI) course duration and preoperative dexamethasone administration. By understanding these differing approaches, healthcare professionals can more effectively manage Graves' disease prior to surgery, resulting in improved patient outcomes and enhanced surgical success.

Effect of Dexamethasone on Post-Operative Delirium in adults following General Anaesthesia

Objective: To determine the effect of Dexamethasone on post-operative delirium in adults following general anaesthesia among patients operated at Pakistan Navy Hospital Shifa.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Anaesthesia and Pain Medicine Departments, Pakistan Navy Hospital Shifa, Karachi Pakistan, from Oct 2019 to Jan 2021.&#x0D; Methodology: Patients operated in the main operation theatre of our hospital during the study period without any complication fulfilling the exclusion/inclusion criteria, were included in the study. They were randomly divided into two groups, with Group-A receiving 4mg Dexamethasone and other routine pre-anaesthetic medications. In contrast, Group-B just received the routine pre-anaesthetic medications but no Dexamethasone. An independent assessor assessed post-operative delirium using the Confusion assessment method (CAM).&#x0D; Results: A total of 250 patients were included in the study, which met the inclusion criteria. The mean age of the study participants was 34.419±4.329 years. 27(10.8%) patients showed post-operative delirium, while 223(89.2%) did not show postoperative delirium on the Confusion assessment method. The chi-square test revealed that none of the factors studied, including the administration of pre-operative Dexamethasone, had any statistically significant relationship with the presence or absence of delirium among the target population (p-value &gt;0.05).&#x0D; Conclusion: Delirium was a fairly common finding in adult patients 24 hours after routine surgical procedures. None of the factors studied, including Dexamethasone, was related to the presence or absence of delirium in our study.

Efficacy of Dexamethasone in Attenuation of Postinduction Hypotension in Geriatric Patients Undergoing General Anesthesia: A Randomized Controlled Trial

Abstract Background Postinduction hypotension is a common problem that faces anesthesiologists on a daily basis, with incidence ranging from 25% to 67.5% when propofol is used as an induction agent. Post-induction Hypotension is even more common in the elder population because increase in age is an independent predictor of intraoperative hypotension as a result of the diminished cardiovascular reserves. Aim of the Work This study assessed the efficacy of dexamethasone to alleviate the drop in blood pressure after induction of anesthesia. All patients were informed of their participation in the study and written consents were taken. They were assessed preoperatively by careful history taking, full physical examination, and laboratory evaluation. Patients and Methods A Prospective randomized clinical study in Ain-Shams University hospitals, Cairo, Egypt form June 15, 2021 to October 15, 2021 on 100 randomly chosen patients aged ≥ 60 years, American Society of Anesthesiologists (ASA) class I or II who were scheduled for elective surgery in Ain Shams University Hospitals, after approval of the medical ethical committee. They were allocated in two groups of 50 patients each. Results The results of the study revealed that the Patients who received preoperative dexamethasone had a significantly less incidence of hypotension, nausea, vomiting and shivering. Accordingly, ephedrine and IV fluid boluses were less frequently needed. Conclusion A single 8 mg IV dexamethasone given two hours preoperatively was able to decrease the incidence of postinduction hypotension in geriatric patients undergoing general anesthesia, leading to decreased use of ephedrine and IV fluid boluses. In addition, a significantly fewer percentage of patients developed nausea, vomiting and shivering after surgery than those who didn’t receive the drug.

Preoperative Submucosal Dexamethasone Injection for Minimizing Postoperative Pain, Trismus, and Oedema Associated with Impacted Mandibular Third Molar Surgery

Aim: Is To evaluate the relative ability of 4mg dose of preoperative Dexamethasone, administered submucosally, to reduce the postoperative pain, swelling and trismus after third molar surgery.&#x0D; Methods: The total 40 patient required surgical removal of a single mandibular third molar were included and divided into two groups, The experimental group (20 cases) received intraoperative submucosal injection of 4 mg Dexamethasone buccally around the tooth at three points after the onset of anesthesia and the control group (20 cases) received no drugs. The maximum interincisal distance and facial contours were measured at baseline and at post-surgery days 2 and 7. The measurement of pain was done using visual analog scale (VAS).&#x0D; Results: There was a statistically significant reduction in the severity of postoperative edema in the experimental group by the second postoperative day. While both groups saw a reduction in discomfort and trismus, there were no statistically significant differences between them.&#x0D; Conclusion: The findings support submucosal injection of Dexamethasone (4 mg) to decrease postoperative edema. Low-dose Dexamethasone injection at the surgical site enhances drug concentration at the injury site without loss owing to diffusion or excretion. The submucosal technique was significantly effective in reduction of postoperative swelling and trismus.

Preoperative Dexamethasone and β2 Agonist Administration to Children with Airway Foreign Bodies: Effects on Intraoperative Respiratory Complications

Background: One of the most challenging operations in children for anesthesiologists and surgeons is foreign body aspiration. Bronchospasm and desaturation may lead to bradycardia and even death. Objectives: The study aimed to evaluate the effect of preoperative dexamethasone and β2 agonist (salbutamol) administration on children who had foreign body aspiration during the rigid bronchoscopy on these undesired complications. Methods: Children were divided into two groups via random numbers table, independent of their clinical conditions. β2 agonist (salbutamol) (2.5 mg &lt; 20 kg, 5 mg &gt; 20 kg) and dexamethasone (0.5 mg/kg) were administrated to group 1, 30 minutes before the operation. The same agents were administrated to group 2 during anesthesia induction. The occurrence of bronchospasm, desaturation, and bradycardia was evaluated. Results: There were 27 children in each group. There was no statistically significant difference between the two groups’ time periods between the onset of the symptoms and procedure (P &gt; 0.05). The two groups were similar in clinical aspects. Clinically, periods of spasm and desaturation were shorter, and patients recovered faster in group 1, but the bronchospasm numbers, desaturation, and bradycardia periods were similar in both groups. Conclusions: The results seem statistically similar. Since the periods of spasm and desaturation were shorter, and patients recovered faster in patients with preoperative administration of β2 agonists (salbutamol) and dexamethasone, we may suggest that a larger data set in future studies may lead to more significant results and a better conclusion.

Preoperative Dexamethasone and β2 Agonist Administration to Children with Airway Foreign Bodies: Effects on Intraoperative Respiratory Complications

Background: One of the most challenging operations in children for anesthesiologists and surgeons is foreign body aspiration. Bronchospasm and desaturation may lead to bradycardia and even death. Objectives: The study aimed to evaluate the effect of preoperative dexamethasone and β2 agonist (salbutamol) administration on children who had foreign body aspiration during the rigid bronchoscopy on these undesired complications. Methods: Children were divided into two groups via random numbers table, independent of their clinical conditions. β2 agonist (salbutamol) (2.5 mg &lt; 20 kg, 5 mg &gt; 20 kg) and dexamethasone (0.5 mg/kg) were administrated to group 1, 30 minutes before the operation. The same agents were administrated to group 2 during anesthesia induction. The occurrence of bronchospasm, desaturation, and bradycardia was evaluated. Results: There were 27 children in each group. There was no statistically significant difference between the two groups’ time periods between the onset of the symptoms and procedure (P &gt; 0.05). The two groups were similar in clinical aspects. Clinically, periods of spasm and desaturation were shorter, and patients recovered faster in group 1, but the bronchospasm numbers, desaturation, and bradycardia periods were similar in both groups. Conclusions: The results seem statistically similar. Since the periods of spasm and desaturation were shorter, and patients recovered faster in patients with preoperative administration of β2 agonists (salbutamol) and dexamethasone, we may suggest that a larger data set in future studies may lead to more significant results and a better conclusion.

Response to Preoperative Dexamethasone Predicts Postoperative Neurological Improvement of Focal Neurological Deficits in Patients With Brain Metastases.

Steroids are used ubiquitously in the preoperative management of patients with brain tumor. The rate of improvement in focal deficits with steroids and the prognostic value of such a response are not known. To determine the rate at which focal neurological deficits respond to preoperative corticosteroids in patients with brain metastases and whether such an improvement could predict long-term recovery of neurological function after surgery. Patients with brain metastases and related deficits in language, visual field, or motor domains who received corticosteroids before surgery were identified. Characteristics between steroid responders and nonresponders were compared. Ninety six patients demonstrated a visual field (13 patients), language (19), or motor (64) deficit and received dexamethasone in the week before surgery (average cumulative dose 43 mg; average duration 2.7 days). 38.5% of patients' deficits improved with steroids before surgery, while 82.3% of patients improved by follow-up. Motor deficits were more likely to improve both preoperatively ( P = .014) and postoperatively ( P = .010). All 37 responders remained improved at follow-up whereas 42 of 59 (71%) of nonresponders ultimately improved ( P < .001). All other clinical characteristics, including dose and duration, were similar between groups. A response to steroids before surgery is highly predictive of long-term improvement postoperatively in brain metastasis patients with focal neurological deficits. Lack of a response portends a somewhat less favorable prognosis. Duration and intensity of therapy do not seem to affect the likelihood of response.

High-dose dexamethasone in low pain responders undergoing total knee arthroplasty: a randomised double-blind trial

BackgroundPostoperative pain after total knee arthroplasty (TKA) is a continuing problem despite optimised multimodal analgesia. Previous studies have shown preoperative glucocorticoids to reduce postoperative pain, but knowledge about specific doses and effects in specific patient groups is lacking. MethodsA two-centre, double-blind, two-arm study comparing preoperative dexamethasone (1 mg kg−1vs 0.3 mg kg−1 i.v.) on postoperative pain in 160 planned TKA subjects with low preoperative pain catastrophising and no opioid use. Subjects received multimodal analgesia with paracetamol, cyclooxygenase-2 inhibitors, local anaesthetic infiltration analgesia, and rescue opioids. The primary outcome was percentage of subjects experiencing moderate to severe pain (visual analogue scale >30 mm) upon ambulation at 24 h. Secondary outcomes included pain scores, postoperative inflammation (C-reactive protein), opioid and antiemetics use, and ‘Quality of Recovery-15’ and ‘Opioid-Related Symptom Distress Scale’, length of stay, readmissions, and complications up to Day 90. ResultsA total of 157 subjects (80 vs 77) were included. No difference was found between groups in the incidence of subjects experiencing visual analogue scale >30 on ambulation 24 h after surgery (56% vs 53%, relative risk =1.07, confidence interval: 0.8–1.4, P=0.65). No differences in other pain outcomes or use of rescue opioids and antiemetics, in Quality of Recovery-15 and Opioid-Related Symptom Distress Scale, length of stay, readmissions, or complications. C-reactive protein values were comparable at 24 h (13 [6–25] mg L−1vs 16 [9–38] mg L−1, P = 0.07), but lower at 48 h (26 [9–52] mg L−1vs 50 [30–72] mg L−1, P<0.01) in the high-dose group. ConclusionUse of 1 mg kg−1vs 0.3 mg kg−1 i.v. dexamethasone in low pain responders after TKA did not improve early postoperative pain or other outcomes in contrast to benefits in a high pain responder population. Clinical trial registrationNCT03758170 (first registration 29-11-2018).

Study of the Effect of Preoperative Dexamethasone before Total Thyroidectomy on Postoperative Nausea, Vomiting, Pain and Voice Dysfunction

Study of the Effect of Preoperative Dexamethasone before Total Thyroidectomy on Postoperative Nausea, Vomiting, Pain and Voice Dysfunction

NIMG-03. PREOPERATIVE DEXAMETHASONE LEADS TO SIGNIFICANT REDUCTIONS IN PERITUMORAL EDEMA FOR PATIENTS WITH BRAIN METASTASES

Abstract INTRODUCTION Corticosteroids are commonly used preoperatively in patients with brain metastases to mitigate symptoms related to vasogenic peritumoral edema (PTE). Though these tumors are highly prevalent, surprisingly few studies have examined the effect of steroids on PTE evident on MRI. We investigated whether steroid administration was associated with greater reduction in PTE in brain metastasis patients compared to steroid-naïve patients. Additionally, we sought to determine if PTE reductions reflect preoperative neurologic improvement and whether an association existed between change in PTE and preoperative steroid dosing. METHODS We identified 27 patients with brain metastases and two pre-operative MRIs—one pre- and one post-steroid administration. PTE and tumor volume was calculated from FLAIR or T2 sequences using 3D Slicer. PTE was quantified with Edema Index (EI). Pertinent demographic, clinical, and dexamethasone dosing data were extracted from patient charts. Descriptive statistics were performed to compare demographic, clinical, and radiographic data between patient strata. A Pearson's R correlation was performed to assess for an association between percent change in PTE and dexamethasone dosing. All statistics were computed in R with a threshold of α= 0.05. RESULTS Patients that received preoperative dexamethasone demonstrated significantly greater percent reduction in PTE compared to their steroid naïve counterparts (p = 0.02). This finding was despite similar time elapsed between MRI studies across both groups. Similar PTE changes were observed in those with and without preoperative neurologic improvement. No significant correlation was found between percent-change in PTE and dexamethasone dosing. CONCLUSIONS We are the first to demonstrate that preoperative dexamethasone administration significantly reduces PTE in patients with brain metastases when compared to a steroid naïve reference group. Curiously, a superior reduction in PTE was not reflective of neurologic improvement. The clinical significance of this merits further study.