Dexamethasone as a part of the multimodal perioperative care for thyroid surgery, literature review

Dexamethasone for thyroid surgery

Abstract

Background and purpose: Thyroidectomies are one of the most common elective surgical procedures in modern medicine. Performed under general anesthesia, thyroidectomies are associated with a high incidence of postoperative nausea and vomiting. Other common complications that increase anxiety among the surgical population are pain, postoperative voice dysfunction, and hypocalcemia. Dexamethasone, as a common adjuvant in anesthesia, is recommended as standard of care for prophylaxis of postoperative nausea and vomiting, as well as in the management of postoperative pain. Recent studies recommended the prophylactic use of dexamethasone in order to prevent hypocalcemia, and voice changes after thyroid surgery.

Materials and methods: A literature review with 35 studies included was done to investigate and evaluate the effect of dexamethasone on the postoperative nausea and vomiting, pain, and voice dysfunction in patients undergoing thyroid surgery.

Results: Dexamethasone seems to be effective for postoperative nausea and vomiting prophylaxis in patients undergoing thyroid surgery in a preoperative single dose of 8-10 mg intravenously. Dexamethasone may have potential in alleviating pain, but the correct dose needs to be determined. Studies supported the prophylaxis with dexamethasone for voice changes and hypocalcemia, but further research is required.

Conclusion: A preoperative single intravenous dose of dexamethasone is a safe and effective method for preventing postoperative nausea and vomiting. Further meta-analyses and high-quality trials are needed to determine the optimal dose for pain relief and to assess its impact on voice changes and hypocalcemia.