1.
Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery: a randomized double-blind placebo-controlled trial.
Schietroma, M, Cecilia, EM, Carlei, F, Sista, F, De Santis, G, Lancione, L, Amicucci, G
JAMA otolaryngology-- head & neck surgery. 2013;(5):471-8
Abstract
IMPORTANCE Recurrent laryngeal nerve dysfunction and hypoparathyroidism are well-recognized, important complications of thyroid surgery. The duration of convalescence after noncomplicated thyroid operation may depend on several factors, of which pain and fatigue are the most important. Nausea and vomiting occur mainly on the day of operation. Glucocorticoids are well known for their analgesic, anti-inflammatory, immune-modulating and antiemetic effects. However, there is little information in the literature on the use of steroids in thyroid surgery, and the information that is available is conflicting. OBJECTIVE To investigate whether preoperative dexamethasone could improve surgical outcome in patients undergoing thyroid surgery. DESIGN A randomized double-blind placebo-controlled trial. A 30-day follow-up for morbidity was performed in all cases. SETTING All patients were hospitalized in a public hospital. PARTICIPANTS From June 2008 through August 2011, 328 patients were randomized to receive either intravenous dexamethasone, 8 mg, administered 90 minutes before skin incision, or saline solution (placebo). INTERVENTIONS Intravenous dexamethasone, 8 mg. MAIN OUTCOMES AND MEASURES The primary end points were temporary or permanent recurrent laryngeal nerve palsy. Transient and definitive hypoparathyroidism, pain and fatigue scores, nausea, and the number of vomiting episodes were also registered. Preoperatively and at several times during the first 24 postoperative hours, we measured C-reactive protein, interleukin 6, and interleukin 1β levels. RESULTS In the dexamethasone group, the rate of temporary recurrent laryngeal nerve palsy (4.9%) was significantly lower compared with the placebo group (8.4%) (P = .04). Also, postoperative transient biochemical hypoparathyroidism occurred more frequently in the placebo group (37.0%) than in the dexamethasone group (12.8%). Dexamethasone use significantly reduced postoperative levels of C-reactive protein (P = .01) and interleukin 6 and interleukin 1β (P = .02), fatigue (P = .01), and overall pain during the first 24 postoperative hours (P = .04), as well as the total analgesic (ketorolac tromethamine) requirement (P = .04). Dexamethasone use also reduced nausea and vomiting on the day of operation (P = .045). CONCLUSIONS AND RELEVANCE Preoperative administration of dexamethasone, 8 mg, reduced postoperative temporary recurrent laryngeal nerve palsy and hypoparathyroidism rates and reduced pain, fatigue, nausea, and vomiting after thyroid surgery. However, these data require further analysis in randomized prospective studies. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT01690806.
2.
[Clinical control trial of methylprednisolone and dexamethasone in treatment of intracranial tumor edema].
Ding, X, Mao, B, Ju, Y, Liu, Y
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition. 2003;(2):327-9
Abstract
OBJECTIVE This study was designed to evaluate the therapeutic effect and side effect of methylprednisolone on brain tumor edema. METHODS Fifty-eight patients with brain tumor edema revealed by CT/MRI were randomly divided into two groups. 30 patients of trial group were treated with methylprednisolone, and 28 patients of the control group received dexamethasone for 3-5 days before and after operation. The patients' clinical neurological symptoms and signs were observed at the beginning and end of treatment before operation, and Karnofsky Performance Scores, were given to the case. Furthermore, the patients' cell immunity, electrolytes, blood sugar that might be affected, by methylprednisolone and dexamethasone were investigated concerned. RESULTS Nineteen of 30 patients taking methylprednisolone and seventeen of 28 patients taking dexamethasone showed improvement in their clinical neurological symptoms, total effective rates for methylprednisolone and dexamethasone groups were 63.0% and 60.7% respectively, there was no obvious difference between the two groups in this regard rate (P > 0.05). Furthermore nine patients (30.0%) in trial group show significant improvement, whereas only four patients (14.3%) in the control group show significant improvement, the difference here was statistically significant (P < 0.05). There was no obvious side effect in both groups during treatment. CONCLUSION Vasogenic edema associated with brain tumor and its induced symptoms was effectively treated by methylprednisolone without adverse effects, Current findings suggest that further study of methylprednisolone in the management of control nervous system tumors is warranted.