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The impact of prophylactic dexamethasone on postoperative sore throat: an updated systematic review and meta-analysis

Authors Jiang Y, Chen R, Xu S, Li J, Yu F, Kong L, Sun Y, Ye Y, Li Y, Yu M, Wu J

Received 27 April 2018

Accepted for publication 6 August 2018

Published 18 October 2018 Volume 2018:11 Pages 2463—2475


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael A Überall

Yaofei Jiang,1–4,* Ruoxi Chen,2,* Suming Xu,2,* Jiaxi Li,2,* Fanqi Yu,2 Lingdong Kong,2 Yuhan Sun,2 Yuan Ye,2 Yimin Li,2 Mengqi Yu,2 Jiaming Wu1

1Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jiaxing University, Jiaxing, China; 2Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China; 3Hubei Cancer Clinical Study Centre, 4Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan, China

*These authors contributed equally to this work

Background/Aims: An updated systematic review and meta-analysis was conducted to assess the effect of prophylactic dexamethasone for tracheal intubation of general anesthesia on ­postoperative sore throat (POST).
Methods: Comprehensive literature search of databases for randomized controlled trials (RCTs), including Embase, PubMed, and Cochrane Library, which evaluate the effect of prophylactic dexamethasone on POST was conducted. RevMan 5.0 and STATA 12.0 software were used to perform meta-analyses.
Results: Fourteen RCTs totaling 1,837 patients were included for analysis. Compared with placebo, a significant reduction in the incidence of POST (OR 0.44, 95% CI 0.33–0.58, P<0.00001), hoarseness (OR 0.42, 95% CI 0.31–0.58, P<0.00001), and postoperative nausea and vomiting (PONV) (OR 0.06, 95% CI 0.03–0.14, P<0.00001) and a comparable incidence of cough (OR 0.59, 95% CI 0.19–1.89, P=0.38) was described in patients receiving dexamethasone, with or without concomitant drugs. Dexamethasone ≥0.2 mg/kg had a statistically greater impact on reducing the incidence of POST than dexamethasone 0.1–0.2 mg/kg, while dexamethasone ≤0.1 mg/kg did not. Dexamethasone was as effective as other drugs such as ondansetron, magnesium sulfate, ketamine gargle, betamethasone gel, and ketorolac for reducing POST (OR 0.70, 95% CI 0.46–1.07, P=0.10). Dexamethasone plus a different drug was more effective than dexamethasone alone for reducing the incidence of POST at 24 hours (OR 0.40, 95% CI 0.21–0.77, P=0.006). Compared with controls, a statistically higher blood glucose level was the only adverse event during the immediate postoperative period in patients receiving dexamethasone.
Conclusions: Intravenous dexamethasone ≥0.2 mg/kg within 30 minutes before or after induction of general anesthesia should be recommended as grade 1A evidence with safety and efficacy in reducing the incidence of POST, hoarseness, and PONV in patients without pregnancy, diabetes mellitus, or contraindications for corticosteroids.

Keywords: systematic review, meta-analysis, corticosteroids, dexamethasone, postoperative sore throat

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