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GENERAL ARTICLES

Small-Dose Dexamethasone Reduces Nausea and Vomiting After Laparoscopic Cholecystectomy: A Comparison of Tropisetron with Saline

Jhi-Joung Wang, MD, DMS^*, Shung-Tai Ho, MD, MS, Yih-Huei Uen, MD, Mao-Tsun Lin, PhD^*, Kuan-Ting Chen, MD^*, Jeng-Chai Huang, PhD^*, and Jann-Inn Tzeng, MD^*

Departments of *Anesthesiology and Surgery, Chi-Mei Medical Center, Tainan, Taiwan; and Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Address correspondence and reprint requests to Jhi-Joung Wang, MD, DMS, Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan. Address e-mail to 400002{at}mail.chimei.org.tw

Dexamethasone is an effective antiemetic drug, but the efficacy of small-dose dexamethasone 5 mg on the prophylaxis of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic chole-cystectomy has not been evaluated. We, therefore, evaluated the prophylactic effect of small-dose dexamethasone (5 mg) on PONV in patients undergoing laparoscopic cholecystectomy. Tropisetron and saline served as controls. One-hundred-twenty patients scheduled for laparoscopic cholecystectomy were enrolled in a randomized, double-blinded, placebo-controlled study. At the induction of anesthesia, the Dexamethasone group received IV dexamethasone 5 mg, the Tropisetron group received IV tropisetron 2 mg, and the Pla- cebo group received IV saline. We found that both dexamethasone and tropisetron significantly decreased the following variables: the total incidence of PONV (P < 0.01), more than four vomiting episodes (P < 0.05), and the proportions of patients requiring rescue antiemetics (P < 0.05). The differences between the Dexamethasone and Tropisetron groups were not significant. We conclude that prophylactic IV dexamethasone 5 mg significantly reduces the incidence of PONV in patients undergoing laparoscopic cholecystectomy. At this dose, dexamethasone is as effective as tropisetron 2 mg and is more effective than placebo.

IMPLICATIONS: We evaluated the prophylactic effect of small-dose dexamethasone (5 mg) on postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy. Tropisetron (2 mg) and saline served as controls. We found that dexamethasone 5 mg (IV) significantly reduced the incidence of PONV in these patients, and, at this dose, dexamethasone was as effective as tropisetron and was more effective than placebo.

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				A. Goldfaden and J. D. Birkmeyer Evidence-Based Practice in Laparoscopic Surgery: Perioperative Care Surgical Innovation, March 1, 2005; 12(1): 51 - 61. [Abstract] [PDF]