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Effect of perioperative dexamethasone on subjective voice quality after thyroidectomy: a meta-analysis and systematic review

  • Systematic Review and Meta-analysis
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Prophylactic dexamethasone has been shown to reduce postoperative pain, nausea, and vomiting in patients undergoing thyroidectomy. However, its effects on postoperative voice outcomes remain uncertain.

Methods

A systematic review and meta-analysis of the literature was conducted. Cochrane database, MEDLINE, EMBASE, and CINAHL were thoroughly searched. Studies that compared intravenous dexamethasone administration with no dexamethasone in patients undergoing thyroidectomy were included. Main outcome measure was the difference in postoperative voice assessment between groups. Standardized mean difference (SMD) and 95 % confidence intervals (CIs) were estimated using fixed and random effects models.

Results

Four studies with a total of 313 patients met inclusion criteria. Significant heterogeneity of study results was noted. Using random effects models, pooled data showed no difference in subjective voice quality between groups preoperatively (SMD, 0.29; 95 % CI −0.37 to 0.96; P = 0.39), 24 h after thyroidectomy (SMD, −1.02; 95 % CI −2.36 to 0.31; P = 0.13), or at 48 h (SMD, −0.05; 95 % CI −0.30 to 0.21; P = 0.72). A sensitivity analysis excluding one observational study yielded similar results.

Conclusion

There are insufficient data for definite conclusions to be drawn regarding the effectiveness of a single perioperative administration of dexamethasone to reduce short-term voice disturbances after thyroidectomy. Further prospective trials using objective voice analysis are warranted to evaluate the efficacy of dexamethasone.

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References

  1. Watt-Boolsen S, Blichert-Toft M, Boberg A (1979) Influence of thyroid surgery on voice function and laryngeal symptoms. Br J Surg 66:535–536

    Article  CAS  PubMed  Google Scholar 

  2. de Pedro Netto I, Fae A, Vartanian JG, Barros AP, Correia LM, Toledo RN, Testa JR, Nishimoto IN, Kowalski LP, Carrara-de Angelis E (2006) Voice and vocal self-assessment after thyroidectomy. Head Neck 28:1106–1114

    Article  PubMed  Google Scholar 

  3. Stevens K, Stojadinovic A, Helou LB, Solomon NP, Howard RS, Shriver CD, Buckenmaier CC, Henry LR (2012) The impact of recurrent laryngeal neuromonitoring on multi-dimensional voice outcomes following thyroid surgery. J Surg Oncol 105:4–9

    Article  PubMed  Google Scholar 

  4. Sinagra DL, Montesinos MR, Tacchi VA, Moreno JC, Falco JE, Mezzadri NA, Debonis DL, Curutchet HP (2004) Voice changes after thyroidectomy without recurrent laryngeal nerve injury. J Am Coll Surg 199:556–560

    Article  PubMed  Google Scholar 

  5. Scerrino G, Inviati A, Di Giovanni S, Paladino NC, Di Paola V, Lo Re G, Almasio PL, Cupido F, Gulotta G, Bonventre S (2013) Esophageal motility changes after thyroidectomy; possible associations with postoperative voice and swallowing disorders: preliminary results. Otolaryngol Head Neck Surg 148:926–932

    Article  PubMed  Google Scholar 

  6. Vicente DA, Solomon NP, Avital I, Henry LR, Howard RS, Helou LB, Coppit GL, Shriver CD, Buckenmaier CC, Libutti SK, Shaha AR, Stojadinovic A (2014) Voice outcomes after total thyroidectomy, partial thyroidectomy, or non-neck surgery using a prospective multifactorial assessment. J Am Coll Surg 219:152–163

    Article  PubMed  Google Scholar 

  7. De Oliveira GS Jr, Almeida MD, Benzon HT, McCarthy RJ (2011) Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 115:575–588

    Article  PubMed  Google Scholar 

  8. De Oliveira GS Jr, Castro-Alves LJ, Ahmad S, Kendall MC, McCarthy RJ (2013) Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg 116:58–74

    Article  PubMed  Google Scholar 

  9. Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS (2013) Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 110:191–200

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Chandrasekhar SS, Randolph GW, Seidman MD, Rosenfeld RM, Angelos P, Barkmeier-Kraemer J, Benninger MS, Blumin JH, Dennis G, Hanks J, Haymart MR, Kloos RT, Seals B, Schreibstein JM, Thomas MA, Waddington C, Warren B, Robertson PJ, American Academy of Otolaryngology – Head and Neck Surgery (2013) Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol Head Neck Surg 148:S1–S37

    Article  PubMed  Google Scholar 

  11. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34

    Article  PubMed  Google Scholar 

  12. Cheng SP, Lee JJ, Liu TP, Yang PS, Liu SC, Hsu YC, Liu CL (2015) Quality of life after surgery or surveillance for asymptomatic primary hyperparathyroidism: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 94, e931

    Article  Google Scholar 

  13. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  14. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed Central  PubMed  Google Scholar 

  15. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  16. Lachanas VA, Exarchos S, Tsiouvaka S, Tsea M, Hajiioannou JK, Skoulakis CE, Bizakis JG (2014) Does perioperative dexamethasone affect voice-related quality of life after thyroidectomy? Eur Arch Otorhinolaryngol 271:3073–3076

    Article  PubMed  Google Scholar 

  17. Nasiri S, Shafag S, Khorgami Z, Sodagari N, Aminian A, Hedayat A (2013) Does corticosteroid have any beneficial effect on voice change after thyroidectomy? Am Surg 79:1258–1262

    PubMed  Google Scholar 

  18. Feroci F, Rettori M, Borrelli A, Lenzi E, Ottaviano A, Scatizzi M (2011) Dexamethasone prophylaxis before thyroidectomy to reduce postoperative nausea, pain, and vocal dysfunction: a randomized clinical controlled trial. Head Neck 33:840–846

    Article  PubMed  Google Scholar 

  19. Worni M, Schudel HH, Seifert E, Inglin R, Hagemann M, Vorburger SA, Candinas D (2008) Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg 248:1060–1066

    Article  PubMed  Google Scholar 

  20. Helidoni ME, Murry T, Moschandreas J, Lionis C, Printza A, Velegrakis GA (2010) Cross-cultural adaptation and validation of the voice handicap index into Greek. J Voice 24:221–227

    Article  PubMed  Google Scholar 

  21. Chen CC, Siddiqui FJ, Chen TL, Chan ES, Tam KW (2012) Dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing thyroidectomy: meta-analysis of randomized controlled trials. World J Surg 36:61–68

    Article  PubMed  Google Scholar 

  22. Zou Z, Jiang Y, Xiao M, Zhou R (2014) The impact of prophylactic dexamethasone on nausea and vomiting after thyroidectomy: a systematic review and meta-analysis. PLoS One 9, e109582

    Article  PubMed Central  PubMed  Google Scholar 

  23. Holte K, Kehlet H (2002) Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 195:694–712

    Article  PubMed  Google Scholar 

  24. Wang JJ, Ho ST, Tzeng JI, Tang CS (2000) The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg 91:136–139

    CAS  PubMed  Google Scholar 

  25. Serpell JW, Woodruff S, Bailey M, Grodski S, Yeung M (2011) Recurrent laryngeal nerve diameter increases during thyroidectomy. Ann Surg Oncol 18:1742–1747

    Article  PubMed  Google Scholar 

  26. Francois B, Bellissant E, Gissot V, Desachy A, Normand S, Boulain T, Brenet O, Preux PM, Vignon P, Association des Reanimateurs du Centre-Ouest (ARCO) (2007) 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial. Lancet 369:1083–1089

    Article  CAS  PubMed  Google Scholar 

  27. Kim MS, Cote CJ, Cristoloveanu C, Roth AG, Vornov P, Jennings MA, Maddalozzo JP, Sullivan C (2007) There is no dose-escalation response to dexamethasone (0.0625–1.0 mg/kg) in pediatric tonsillectomy or adenotonsillectomy patients for preventing vomiting, reducing pain, shortening time to first liquid intake, or the incidence of voice change. Anesth Analg 104:1052–1058

    Article  CAS  PubMed  Google Scholar 

  28. Cheng SP, Lee JJ, Liu TP, Lee KS, Liu CL (2012) Preoperative ultrasonography assessment of vocal cord movement during thyroid and parathyroid surgery. World J Surg 36:2509–2515

    Article  PubMed  Google Scholar 

  29. Lombardi CP, D’Alatri L, Marchese MR, Maccora D, Monaco ML, De Crea C, Raffaelli M (2012) Prospective electromyographic evaluation of functional postthyroidectomy voice and swallowing symptoms. World J Surg 36:1354–1360

    Article  PubMed  Google Scholar 

  30. Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L, Amicucci G (2013) Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery: a randomized double-blind placebo-controlled trial. JAMA Otolaryngol Head Neck Surg 139:471–478

    Article  PubMed  Google Scholar 

  31. Wang LF, Lee KW, Kuo WR, Wu CW, Lu SP, Chiang FY (2006) The efficacy of intraoperative corticosteroids in recurrent laryngeal nerve palsy after thyroid surgery. World J Surg 30:299–303

    Article  PubMed  Google Scholar 

  32. Tarantino I, Warschkow R, Beutner U, Kolb W, Luthi A, Luthi C, Schmied BM, Clerici T (2015) Efficacy of a single preoperative dexamethasone dose to prevent nausea and vomiting after thyroidectomy (the tPONV Study): a randomized, double-blind, placebo-controlled clinical trial. Ann Surg. doi:10.1097/SLA.0000000000001112

    Google Scholar 

  33. Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, Zhang K, Cakmakkaya OS (2012) Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 109:742–753

    Article  CAS  PubMed  Google Scholar 

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Authors’ contributions

Study conception and design: SPC, TPL, and CLL

Acquisition of data: SPC and CLL

Analysis and interpretation of data: SPC, TPL, PSY, KSL, and CLL

Drafting of manuscript: SPC

Critical revision of manuscript: TPL, PSY, KSL, and CLL

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Authors and Affiliations

  1. Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, 92, Chung-Shan North Road, Section 2, Taipei, 10449, Taiwan

    Shih-Ping Cheng, Tsang-Pai Liu, Po-Sheng Yang & Chien-Liang Liu

  2. Department of Otorhinolaryngology, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan

    Kuo-Sheng Lee

  3. Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan

    Tsang-Pai Liu, Kuo-Sheng Lee & Chien-Liang Liu

  4. Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan

    Shih-Ping Cheng & Po-Sheng Yang

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  1. Shih-Ping Cheng
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Correspondence to Chien-Liang Liu.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Cheng, SP., Liu, TP., Yang, PS. et al. Effect of perioperative dexamethasone on subjective voice quality after thyroidectomy: a meta-analysis and systematic review. Langenbecks Arch Surg 400, 929–936 (2015). https://doi.org/10.1007/s00423-015-1354-3

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  • DOI: https://doi.org/10.1007/s00423-015-1354-3

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