Small-dose dexamethasone improves quality of recovery scores after elective cardiac surgery: a randomized, double-blind, placebo-controlled study.

Author(s): Murphy GS, Sherwani SS, Szokol JW, Avram MJ, Greenberg SB, Patel KM, Wade LD, Vaughn J, Gray J.

Affiliation(s): Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, IL 60201, USA. dgmurphy2@yahoo.com

Publication date & source: 2011, J Cardiothorac Vasc Anesth. , 25(6):950-60

OBJECTIVES: The use of steroid therapy in cardiac surgical patients remains controversial. The aim of this clinical investigation was to determine the effect of small-dose dexamethasone therapy on patient-perceived quality of recovery (QoR) scores in elective cardiac surgical patients. In addition, the authors assessed the impact of dexamethasone on the incidence of common adverse events after cardiopulmonary bypass (CPB). DESIGN: A prospective, randomized study. SETTING: University hospitals. PARTICIPANTS: One hundred seventeen patients undergoing cardiac surgery with CPB and anticipated early tracheal extubation. INTERVENTIONS: Subjects were randomized to receive either dexamethasone (dexamethasone group, 8 mg at the induction of anesthesia and at the initiation of CPB) or placebo (control group, saline). MEASUREMENTS AND MAIN RESULTS: The QoR was assessed using the QoR-40 scoring system preoperatively and on postoperative days (PODs) 1 and 2. Secondary outcome measures assessed in the postoperative period included nausea, vomiting, fatigue, febrile responses, shivering, pulmonary gas exchange, and analgesic requirements. Global QoR-40 scores (median [range]) were higher in the dexamethasone group compared with the control group on POD 1 (167 [133-192] v 157 [108-195]; p < 0.0001) and POD 2 (173 [140-196] v 166 [122-196]; p = 0.001). In the dexamethasone group, improved QoR was observed in the QoR-40 dimensions of emotional state (p = 0.002), physical comfort (p = 0.0001-0.006), and pain (p < 0.0001). The incidences or severity of postoperative fatigue (p < 0.0001), febrile responses (p < 0.0001), and shivering (p = 0.001) were reduced in the dexamethasone group. CONCLUSIONS: Patient-perceived postoperative QoR in cardiac surgical patients is enhanced significantly by small-dose dexamethasone treatment.