Dexamethasone effectively reduces postoperative nausea and vomiting in a general surgical adult patient population

Background: Postoperative nausea and vomiting (PONV) is still a common and major complication for surgical patients, which may delay post-anesthetic care unit discharge, prolong hospital stay and thus increase the cost of hospitalization. It is understood that PONV is a multi-factorial outcome and occurs more often with general anesthesia than with other anesthetic methods. Prophylactic administration of antihistamines, antidopaminergics, anticholinergics, phenothiazines, serotonin antagonist, steroids and even acupuncture has been shown to be effective. However, expenses and side effects of these agents have also been a concern for clinical doctors. The aim for this prospective study was to find an agent that is cost effective and side effect free (or at least with a low incidence of side effects) for the prevention of PONV. Methods: A total of 700 adult surgical patients who planned to have surgery under general anesthesia were enrolled in this double-blinded, randomized and placebo-controlled study. Group P received the placebo (0.9% normal saline 2 ml) and Group D received 10 mg dexamethasone intravenously right before the induction of anesthesia. Results: We found that during the postoperative period of 1-8 h, patients in Group D reported a lower incidence of PONV (24%) than those in Group P (39%, p < 0.001). Patients in Group D also requested less rescue anti-emetic (17%) than those in Group P (30%, p < 0.05). The same phenomenon was also noted in the 8-to-24-hour interval (PONV 4% vs. 12%, p < 0.05 and rescue anti-emetic 3% vs. 9%, p < 0.05 in Group D vs. Group P, respectively.) Conclusions: We conclude that the prophylactic intravenous administration of 10 mg dexamethasone immediately before the induction of anesthesia is effective in preventing PONV in the general surgical adult patient population.