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Preoperative intravenous dexamethasone prevents tracheal intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis

  • Akira KuriyamaEmail author
  • Hirokazu Maeda
Review Article/Brief Review

Abstract

Background

Postoperative sore throat related to tracheal intubation negatively affects patient recovery and satisfaction. Previous reviews suggested that intravenous dexamethasone diminishes postoperative sore throat. Nevertheless, they comprised a small number of studies with inconsistencies in outcome reporting. We performed a systematic review and meta-analysis to assess the efficacy and safety of preoperative intravenous dexamethasone in preventing postoperative sore throat in adult patients.

Methods

We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to August 24, 2018. We included randomized-controlled trials that assessed the efficacy and safety of intravenous dexamethasone in adult surgical patients who required general anesthesia and endotracheal intubation. Our primary outcomes were the incidence and severity of sore throat at 24 hr after surgery/extubation and adverse events. We pooled the data using a random-effects model. We conducted a trial sequential analysis (TSA) on the incidence of sore throat.

Results

We included 15 randomized-controlled trials involving 1,849 patients. In comparison with non-analgesic methods, intravenous dexamethasone was associated with a reduced incidence (risk ratio, 0.62; 95% confidence interval [CI], 0.51 to 0.75) and severity (standardized mean difference, − 1.06; 95% CI, − 1.80 to − 0.33) of postoperative sore throat. Serious adverse events were not associated with intravenous dexamethasone administration in the four studies where this was assessed. The TSA indicated that the evidence regarding the incidence of postoperative sore throat is adequate.

Conclusions

Our study indicates that preoperative intravenous administration of dexamethasone alleviates postoperative sore throat more effectively than non-analgesic methods.

Trial registration

PROSPERO (CRD42018086697); registered 29 January, 2018.

La dexaméthasone intraveineuse préopératoire évite le mal de gorge dû à l’intubation trachéale chez des patients chirurgicaux adultes : revue systématique de la littérature et méta-analyse

Résumé

Contexte

Le mal de gorge postopératoire lié à l’intubation trachéale a une répercussion négative sur la récupération et la satisfaction des patients. Des synthèses antérieures ont suggéré que la dexaméthasone intraveineuse diminue le mal de gorge postopératoire. Néanmoins, elles n’incluaient qu’un petit nombre d’études avec des incohérences dans la présentation des résultats. Nous avons réalisé une revue systématique de la littérature et une méta-analyse pour évaluer l’efficacité et l’innocuité de la dexaméthasone intraveineuse préopératoire pour prévenir le mal de gorge postopératoire chez des patients adultes.

Méthodes

Nous avons recherché les essais contrôlés pertinents dans PubMed, EMBASE et le Cochrane Central Register depuis leur création jusqu’au 24 août 2018. Nous avons inclus les essais contrôlés randomisés ayant évalué l’efficacité et l’innocuité de la dexaméthasone intraveineuse chez des patients chirurgicaux adultes ayant nécessité une anesthésie générale et une intubation endotrachéale. Nos principaux critères d’évaluation étaient l’incidence et la sévérité du mal de gorge 24 heures après la chirurgie/extubation et les événements indésirables. Nous avons regroupé les données en utilisant un modèle à effets aléatoires. Nous avons mené une analyse séquentielle des essais sur l’incidence du mal de gorge.

Résultats

Nous avons inclus 15 essais contrôlés randomisés ayant réuni 1 849 patients. Comparativement aux méthodes sans analgésiques, la dexaméthasone a été associée à une diminution de l’incidence (rapport de risque, 0,62; intervalle de confiance [IC] à 95 % : 0,51 à 0,75) et de la sévérité (différence des moyennes standardisées : -1,06; IC à 95 %, -1,80 à -0,33) du mal de gorge postopératoire. Aucun événement indésirable grave n’a été associé à l’administration intraveineuse de dexaméthasone dans les quatre études où ils ont été évalués. L’analyse séquentielle des essais a indiqué que la preuve concernant l’incidence du mal de gorge postopératoire est adéquate.

Conclusions

Notre étude indique que l’administration intraveineuse préopératoire de dexaméthasone soulage plus efficacement le mal de gorge postopératoire que les méthodes sans analgésiques.

Enregistrement de l’essai clinique

PROSPERO (CRD42018086697); enregistré 29 janvier 2018.

Notes

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Steven Backman, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Akira Kuriyama contributed substantially to all aspects of this manuscript, including study conception and design, acquisition, analysis, and interpretation of data, and drafting the article. Hirokazu Maeda contributed substantially to the acquisition of data, interpretation of data, and drafting the article.

Financial disclosures

None.

Supplementary material

12630_2018_1288_MOESM1_ESM.pdf (45 kb)
eTable Subgroup and sensitivity analysis for the comparison of corticosteroids vs non-analgesic controls. Supplementary material 1 (PDF 44 kb)
12630_2018_1288_MOESM2_ESM.pdf (93 kb)
eFigure Bubble plot depicting the association between the efficacy and dose of dexamethasone. Each bubble represents a study and the size of the bubble corresponds to the size of a study. Although there appears to be an inverse relationship between log RR, which represents the log-transformed effect size and dose of dexamethasone, the effect is not significant. RR = risk ratio. Supplementary material 2 (PDF 92 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Emergency and Critical Care CenterKurashiki Central HospitalOkayamaJapan
  2. 2.Department of Emergency MedicineSugita Genpaku Memorial Obama Municipal HospitalFukuiJapan

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