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INTRAVENOUS ANESTHESIA

The Effect of Timing of Dexamethasone Administration on Its Efficacy as a Prophylactic Antiemetic for Postoperative Nausea and Vomiting

Jhi-Joung Wang, MD, DMSc^*,, Shung-Tai Ho, MD^*, Jann-Inn Tzeng, MD, and Chao-Shun Tang, PhD

Departments of Anesthesiology, *Tri-Service General Hospital, National Defense Medical Center and Cathay General Hospital, Taipei; and Department of Anesthesiology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Address correspondence and reprint requests to Jhi-Joung Wang, MD, DMSc, Department of Anesthesiology, Tri-Service General Hospital/National Defense Medical Center, No 8, Sec. 3, Ting-Chow Rd., Taipei, Taiwan. Address e-mail to painlab{at}tpts5.seed.net.tw

Abstract

We evaluated the timing effect of a 10-mg IV administration of dexamethasone on its efficacy as a prophylactic antiemetic on postoperative nausea and vomiting (PONV). One hundred twenty women (n = 40 in each of three groups) undergoing abdominal total hysterectomy under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study. Group 1 received dexamethasone before the induction of anesthesia, Group 2 received dexamethasone at the end of anesthesia, and Group 3 received placebo (saline). The incidence of PONV was evaluated. During the postoperative period of 0–2 h, patients in Group 1 reported a less frequent incidence of PONV (15%) than those in Groups 2 and 3 (45% and 53%, respectively). Patients in Group 1 also requested less rescue antiemetic (8%) than those in Groups 2 and 3 (30% and 35%, respectively). During the postoperative period of 2–24 h, patients in both Groups 1 and 2 reported less frequent incidences of PONV (25% and 28%) and requested fewer rescue antiemetics (13% and 15%) than those in Group 3 (55% and 38%, respectively). In conclusion, the prophylactic IV administration of dexamethasone immediately before the induction, rather than at the end of anesthesia, was more effective in preventing PONV.

Implications: We evaluated the effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic on postoperative nausea and vomiting. We found that dexamethasone, when given immediately before the induction of anesthesia, was more effective than when given at the end of anesthesia.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999