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Anesthesia & Analgesia:
doi: 10.1213/ANE.0b013e31826f0a0a
Ambulatory Anesthesiology: Research Reports

Dexamethasone to Prevent Postoperative Nausea and Vomiting: An Updated Meta-Analysis of Randomized Controlled Trials

De Oliveira, Gildasio S. Jr. MD, MSCI; Castro-Alves, Lucas J. Santana MD; Ahmad, Shireen MD; Kendall, Mark C. MD; McCarthy, Robert J. PharmD

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From the Department of Anesthesiology, Northwestern University, Chicago, Illinois.

Accepted for publication July 31, 2012.

Published ahead of print December 7, 2012

Funded by the Department of Anesthesiology, Northwestern University.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Gildasio S. De Oliveira Jr., MD, MSCI, Department of Anesthesiology, Northwestern Memorial Hospital, 251 E Huron St, F5-704, Chicago, IL 60611. Address e-mail to G-jr@northwestern.edu.

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Abstract

BACKGROUND: Dexamethasone has an established role in decreasing postoperative nausea and vomiting (PONV); however, the optimal dexamethasone dose for reducing PONV when it is used as a single or combination prophylactic strategy has not been clearly defined. In this study, we evaluated the use of 4 mg to 5 mg and 8 mg to 10 mg IV doses of dexamethasone to prevent PONV when used as a single drug or as part of a combination preventive therapy.

METHODS: A wide search was performed to identify randomized clinical trials that evaluated systemic dexamethasone as a prophylactic drug to reduce postoperative nausea and/or vomiting. The effects of dexamethasone dose were evaluated by pooling studies into 2 groups: 4 mg to 5 mg and 8 mg to 10 mg. The first group represents the suggested dexamethasone dose to prevent PONV by the Society for Ambulatory Anesthesia (SAMBA) guidelines, and the second group represents twice the dose range recommended by the guidelines. The SAMBA guidelines were developed in response to studies, which have been performed to examine different dosages of dexamethasone.

RESULTS: Sixty randomized clinical trials with 6696 subjects were included. The 4-mg to 5-mg dose dexamethasone group experienced reduced 24-hour PONV compared with control, odds ratio (OR, 0.31; 95% confidence interval [CI], 0.23–0.41), and number needed to treat (NNT, 3.7; 95% CI, 3.0–4.7). When used together with a second antiemetic, the 4-mg to 5-mg dexamethasone group also experienced reduced 24-hour PONV compared with control (OR, 0.50; 95% CI, 0.35–0.72; NNT, 6.6; 95% CI, 4.3–12.8). The 8-mg to 10-mg dose dexamethasone group experienced decreased 24-hour PONV compared with control (OR, 0.26; 95% CI, 0.20–0.32; NNT, 3.8; 95% CI, 3.0–4.3). Asymmetric funnel plots were observed in the 8-mg to 10-mg dose analysis, suggesting the possibility of publication bias. When used together with a second antiemetic, the 8-mg to 10-mg dose group also experienced reduced incidence of 24-hour PONV (OR, 0.35; 95% CI, 0.22–0.53; NNT, 6.2; 95% CI, 4.5–10). In studies that provided a direct comparison between groups, there was no clinical advantage of the 8-mg to 10-mg dexamethasone dose compared with the 4-mg to 5-mg dose on the incidence of postoperative nausea and/or vomiting.

CONCLUSIONS: Our results showed that a 4-mg to 5-mg dose of dexamethasone seems to have similar clinical effects in the reduction of PONV as the 8-mg to 10-mg dose when dexamethasone was used as a single drug or as a combination therapy. These findings support the current recommendation of the SAMBA guidelines for PONV, which favors the 4-mg to 5-mg dose regimen of systemic dexamethasone.

Dexamethasone is a corticosteroid antiinflammatory drug with an established role for the prevention of postoperative nausea and vomiting (PONV). The Society for Ambulatory Anesthesia (SAMBA) guidelines for the management of PONV recommends a prophylactic dose of 4 mg to 5 mg for patients at high risk of PONV regardless of the surgical procedure.1 A previous systematic review, evaluating patients undergoing various surgical procedures, did not address the effect of varying doses of dexamethasone on PONV.2 Using a meta-analysis, Karanicolas et al.3 evaluated patients undergoing laparoscopic cholecystectomy and suggested a greater efficacy to reduce PONV from a systemic dose of dexamethasone 8 mg to 16 mg compared with 2 mg to 5 mg. The generalizability of these findings to patients undergoing other surgical procedures has not been established. It also remains unclear whether varying doses of dexamethasone may have different efficacy when administered alone or in conjunction with other antiemetic drugs.

The primary objective of this study was to examine the effects of 4 mg to 5 mg and 8 mg to 10 mg single dose systemic dexamethasone on the incidence of PONV. A secondary objective was to evaluate whether the effect changed when dexamethasone was administered alone or in a combination regimen with another antiemetic drug.

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METHODS

This quantitative systematic review was conducted following the guidelines of the PRISMA statement.4

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Systematic Search

Published reports of randomized trials evaluating the effects of dexamethasone on postoperative nausea and/or vomiting were searched using the National Library of Medicine’s PubMed database, EMBASE, the Cochrane Database of Systematic Reviews, and Google Scholar inclusive to October 1, 2011. The initial search was performed using the free-text and MeSH terms “dexamethasone.” The “and” function was used to combine the initial search with the MeSH terms “postoperative” and “nausea.” No language restriction was used. The search was then limited to randomized controlled clinical trials in subjects older than 18 years. An attempt to identify additional studies not found by the primary search methods was performed by reviewing the reference lists from identified studies. No search was performed for unpublished studies. This initial search yielded 163 randomized clinical trials.

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Selection of Included Studies

The study’s inclusion and exclusion criteria were determined before the systematic search. Two authors (GDO and LJCA) independently evaluated the abstracts and results of the 163 articles obtained by the initial search. Seventy-four articles that were clearly not relevant based on our inclusion and exclusion criteria were excluded at this phase. Disagreements on inclusion of the articles were resolved by discussion among the evaluators. If an agreement could not be reached, the dispute was resolved with the help of a third investigator (SA).

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Inclusion and Exclusion Criteria

We included randomized controlled trials of a single perioperative IV dexamethasone administration with an inactive (placebo or “no treatment”) control group. Excluded were trials reporting nausea and vomiting after emergency medicine and nonsurgical patients. Trials in which the same subject received more than a single systemic dose of perioperative dexamethasone were also excluded to maximize clinical homogeneity. Studies involving a comparison of the combination of dexamethasone with a second antiemetic versus that of other antiemetic alone were included, with the combination group being the active group and the other antiemetic serving as control. Included studies had to report at least on early (≤6 hours) or 24-hour incidence of postoperative nausea and/or vomiting. Since we estimated the effects of a fixed dose regimen of dexamethasone, we excluded studies that used weight-dependent–based dosage. We also excluded comparisons or studies that were outside the dosage range examined. Studies performed by the author Yoshitaka Fujii have been excluded because of the questioned validity of these studies’ findings.5 No minimum sample size was required for inclusion in the meta-analysis.

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Validity Scoring

Two authors (GSD and LJCA) independently read the included reports and assessed their methodologic validity using a modified Jadad 5-point quality scale.6 The scale evaluates the study for the following: randomization, double-blind evaluation, concealment of study group to evaluator, valid randomization method, and completeness of data at follow-up. Discrepancies in rating of the trials were resolved by discussion among the evaluators. If an agreement could not be reached, the dispute was resolved with the help of a third investigator (SA). Because only randomized trials were included in the analysis, the minimum possible score of an included trial was 1, and the maximum was 5. Trials were not excluded or weighted in the analysis based on quality assessment scores.

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Data Extraction

Two authors (GDO and LJCA) independently evaluated the full manuscripts of all included trials and performed data extraction using a data collection form specifically developed for this review.

Discrepancies were resolved by discussion between the 2 investigators. If an agreement could not be reached, the decision was made by a third investigator (SA). In addition, one author (MCK) cross-checked the data extraction to assure accuracy. Data extracted from trials included dexamethasone dose and time of administration, sample size, number of subjects in treatment groups, follow-up period, type of surgery, nausea and/or vomiting over 24 hours, early nausea and/or vomiting (≤6 hours), need for rescue antiemetics, and type of drug intervention (single regimen versus combination therapy).

Data were initially extracted from tables. For data not available in tables, attempts to contact authors were made; if the authors did not respond or did not have current contact information, the data were abstracted from available figures. Dichotomous data were extracted and converted to incidence while continuous data were recorded using mean and standard deviation. Data presented only as median and range were converted to mean and standard deviation using previously described methodology.7 If studies reported the proportion of patients free of nausea and/or vomiting, the actual proportion of nausea and/or vomiting was obtained by subtracting the proportion of patients not experiencing nausea and/or vomiting from one.

To perform a quantitative analysis and to examine dose dependency of the outcomes, comparisons were stratified by dose into 2 groups: 4-mg to 5-mg and 8-mg to 10-mg dose groups. The dosage ranges were derived from clinical guidelines for PONV, which suggests a 4-mg to 5-mg dose for antiemetic prophylaxis.1 As stated in the PONV guidelines, “The corticosteroid, dexamethasone, effectively prevents nausea and vomiting. It is recommended at a prophylactic dose of 4–5 mg IV (depending on the dosage formulation in different countries) for patients at increased risk for PONV.” The other dosage group represents twice the dosage range of systemic dexamethasone recommended by SAMBA guidelines for PONV. The SAMBA guidelines were developed in response to studies that have been performed to examine different dosages of dexamethasone.

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Definition of Relevant Outcome Data

Our primary outcomes were 24-hour incidence of PONV (defined as nausea and/or vomiting), early (≤6 hours postoperatively) incidence of PONV, early and 24-hour incidence of nausea, and early and 24-hour incidence of vomiting (including retching). Our secondary outcomes were early (≤6 hours) and 24 hours need for rescue antiemetics.

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Meta-Analyses

For dichotomous data, odds ratio (OR) and 95% confidence interval (CI) are reported. The weighted mean differences with 95% CI were determined and reported for continuous data. We calculated the number needed to treat (NNT) based on the absolute risk reduction, with 95% CI as an estimate of a beneficial effect. Because of the different surgical procedures, a random-effects model was used in an attempt to generalize our findings to studies not included in our meta-analysis.8 A random-effects meta-analysis to estimate the NNT was performed by combining absolute risk differences of individual studies and also using the method of moments to estimate the variance component. Publication bias was evaluated by examining for asymmetric funnel plots using Egger regression test.9 A one-sided P < 0.05 was considered an indication of an asymmetric funnel plot. The heterogeneity of the included studies was considered to be present if the I2 statistic was >30%. Further analysis was planned a priori to explore relevant heterogeneity. Subgroup analysis was performed to investigate the effect of type of antiemetic intervention (single therapy versus combination therapy) and the type of anesthesia (general versus regional/local). In studies that involved more than one dose group comparison with a single control group, the control group was split according to the number of comparisons. A Q statistic was used to compare the effects between subgroups. The proportion of the total variance explained by the covariates (R2) was calculated by dividing the random-effects pooled estimates of variance (J2) within studies by total variance (total J2). The value obtained was then subtracted from 1. When values were outside the range of 0% to 100%, they were set to the closest value (0% or 100%). Comparisons between the different dosage groups of dexamethasone were made using a Z test. Analysis was performed using Stata version 11 (Stata Corp, College Station, TX) and Comprehensive Meta-analysis software version 2 (Biostat, Englewood, NJ).

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RESULTS

Of the 163 initially evaluated abstracts, 89 studies initially met the inclusion criteria (Fig. 1). Twenty-nine studies were subsequently excluded: 12 did not provide a direct comparison between dexamethasone and placebo,10–21 9 did not report on the evaluated outcomes,22–30 3 examined multiple doses of dexamethasone,31–33 3 used a weight-based dosage,34–36 and 2 used a dose range outside the predetermined dosage groups.37,38 Among the excluded trials, exclusion of 4 trials was performed after discussion between 2 investigators (GDO and LJCA).26–29 The characteristics of included studies are listed in Table 1. The evaluated trials included data from 6696 subjects and were published between 1994 and 2011.39–98 The median number of patients in the included studies receiving dexamethasone was 40. The median modified Jadad scale score was 4. The trials tested single dose dexamethasone given either preoperatively or intraoperatively for a large variety of surgical procedures. All 60 studies reported on nausea and/or vomiting. Discrepancies on data extraction were resolved with discussion between 2 investigators (GDO and LJCA) for 8 trials.39,40,48,52,70,81,83,93 For 2 trials, data extraction discrepancies were resolved with the help of a third investigator (SA).60,87

Table 1
Table 1
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Figure 1
Figure 1
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Twenty-Four–Hour Nausea and/or Vomiting (PONV)

The effect of dexamethasone on PONV by dosing groups is presented in Figure 2. Heterogeneity was low for both dose group comparisons (I2 < 30%).

Figure 2
Figure 2
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The calculated NNT values for the aggregated effect of the 4-mg to 5-mg and the 8-mg to 10-mg dose groups compared with control were 3.7 (95% CI, 3.0–4.7) and 3.8 (95% CI, 3.0–4.3), respectively. The funnel plot did not demonstrate asymmetry (P = 0.06) for the 4-mg to 5-mg group comparison but it did for the 8-mg to 10-mg dose group comparison (P = 0.003). Five studies directly compared the effect of the 8-mg to 10-mg dose group with 4-mg to 5-mg dose group on the incidence of 24-hour PONV.63,81,84,85,89 The combined effect showed a wide CI relative to a significant clinical benefit (OR, 0.72; 95% CI, 0.45–1.17).

Three studies provided 3 comparisons of the 4-mg to 5-mg dose used as a second antiemetic to prevent 24-hour PONV.54,74,93 The studies used 2 mg IV haloperidol,54 12.5 mg IV dolasetron,74 and 1 mg IV granisentron93 as the first antiemetic. The 4-mg to 5-mg dose dexamethasone group showed a benefit compared with the control group when used with a second antiemetic (OR, 0.50; 95% CI, 0.35–0.72; NNT, 6.6; 95% CI, 4.3–12.8). Seven studies provided 7 comparisons of 8-mg to 10-mg dose used with a second antiemetic to prevent 24-hour PONV.50,53,57,59,70,71,88 The studies used 0.075 mg/kg IV midazolam,50 4 mg IV ondasentron,53 1 mg IV granisetron,57 10 mg IV metoclopramide,59 50 mg per os dolasetron, 70 40 µg/kg granisetron,71 and 1.25 mg IV droperidol88 as the first antiemetic. The 8-mg to 10-mg dexamethasone dose group also showed a benefit compared with control when used with a second antiemetic (OR, 0.35; 95% CI, 0.22–0.53; NNT, 6.2; 95% CI, 4.5–10).

The effect of dexamethasone on 24-hour incidence of PONV was not significantly different for studies performed under general anesthesia (OR, 0.29; 95% CI, 0.24–0.35) compared with studies performed under regional/local anesthesia (OR, 0.26; 95% CI, 0.17–0.38; P = 0.10).

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Early (0–6 Hours) Nausea and/or Vomiting

The effect of dexamethasone on early PONV by dosing groups is shown in Figure 3. The calculated NNT values for the aggregated effects of the 4-mg to 5-mg and the 8-mg to 10-mg dose groups were 10 (95% CI, 5.5–76.9) and 5.5 (95% CI, 4.0–9.0), respectively. Heterogeneity was low for the 4-mg to 5-mg dose group (I2 = 0) and mild for the 8-mg to 10-mg dose group (I2 = 33%). Heterogeneity could not be explained by studies evaluating dexamethasone with a second antiemetic. An examination of the funnel plot did not reveal asymmetry for the 4-mg to 5-mg dose group (P = 0.16) but it did for the 8-mg to 10-mg dose group (P = 0.01), suggesting the possibility of publication bias.

Figure 3
Figure 3
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Eight studies provided 8 comparisons of 8-mg to 10-mg doses of dexamethasone to prevent early PONV when used with a second antiemetic.53,57,70,71,72,75,80,88 The studies used 4 mg IV ondansetron,53,72,80 1 mg IV granisetron,57 50 mg per os dolasetron,70 40 µg/kg granisetron,71 3 mg IV granisetron,75 and 1.25 mg IV droperidol88 as the other antiemetic. Subgroup analysis showed a statistically significant reduction in the incidence of early PONV in the 8-mg to 10-mg dexamethasone dosage with a second antiemetic group (NNT, 12.5; 95% CI, 8.3–33.3). Two studies examined the effect of the 4-mg to 5-mg doses used with a second antiemetic, but neither showed a significant benefit compared with control.54,72 The studies used 2 mg IV haloperidol54 and 4 mg IV ondansetron72 as the first antiemetic.

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Twenty-Four–Hour Incidence of Nausea

The overall effect of dexamethasone (as a single drug or as part of a combined regimen) on the 24-hour incidence of nausea compared with control is presented in Figure 4. Heterogeneity was low (I2 = 0) for both dose group comparisons.

Figure 4
Figure 4
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The calculated NNT values for the combined effect of the 4-mg to 5-mg and the 8-mg to 10-mg dose groups were 7.1 (95% CI, 5.3–11.1) and 7.5 (95% CI, 6.0–10.2), respectively. The funnel plot did not show asymmetry for the 4-mg to 5-mg dose (P = 0.08) but it did for the 8-mg to 10-mg dose group (P = 0.003). Five studies directly compared the 8-mg to 10-mg with the 4-mg to 5-mg dose groups on the incidence of the 24-hour nausea.63,81,84,85,89 The combined effect showed a wide CI relative to a significant clinical benefit (OR, 0.86; 95% CI, 0.47–1.55).

Two studies provided 2 comparisons of the 4-mg to 5-mg dexamethasone dose used with a second antiemetic to prevent 24-hour nausea.54,93 The studies used 2 mg IV haloperidol54 and 1 mg IV granisetron 93 as the first antiemetic. The effect of the 4-mg to 5-mg dexamethasone dose was detected when administered with a second antiemetic (OR, 0.51; 95% CI, 0.32–0.80; NNT, 8.0; 95% CI, 5.3–10.9). Seven studies provided 7 comparisons of the 8-mg to 10-mg dexamethasone dose used with a second antiemetic to prevent 24-hour nausea.45,50,53,57,70,88,97 The studies used 10 mg IV metoclopramide,45 0.075 mg/kg IV midazolam,50 4 mg IV ondasentron,53,97 1 mg IV granisetron,57 50 mg per os dolasetron,70 and 1.25 mg IV droperidol88 as the other antiemetic. A significant effect was also detected for the 8-mg to 10-mg dose group when dexamethasone was used with a second antiemetic (OR, 0.44; 95% CI, 0.26–0.75; NNT, 10.4; 95% CI, 5.9–43.4).

The effect of dexamethasone on the 24-hour incidence of nausea was not significantly different for studies performed under general anesthesia (OR, 0.43; 95% CI, 0.35–0.53) compared with studies performed under regional/local anesthesia (OR, 0.38; 95% CI, 0.25–0.60; P = 0.54).

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Early (0–6 Hours) Incidence of Nausea

The effect of dexamethasone on the incidence of early nausea by dosing groups is presented in Figure 5. Heterogeneity was low for both dose group comparisons (I2 = 0).

Figure 5
Figure 5
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The calculated NNT values for the combined effect of the 4-mg to 5-mg and the 8-mg to 10-mg dose groups were 26.1 (95% CI, 13.1–1000) and 10.3 (95% CI, 7.4–16.6), respectively. The funnel plot did not demonstrate asymmetry for the 4-mg to 5-mg dose group (P = 0.37), but it showed some asymmetry for the 8-mg to 10-mg dose group (P = 0.02).

Three studies examined a 4-mg to 5-mg dexamethasone group used with a second antiemetic.54,72,74 The studies used 2 mg IV haloperidol,54 4 mg IV ondansetron,72 and 12.5 mg IV dolasetron74 as the other antiemetic. The combined effect did not show a benefit compared with control on the incidence of early nausea (OR, 0.63; 95% CI, 0.34–1.17). Twelve studies provided 11 comparisons of the 8-mg to 10-mg dexamethasone used with a second antiemetic to prevent early nausea.39,45,53,57,59,71,72,75,80,88,96,97 The studies used 4 mg IVondansetron,39,53,72,80,96,97 10 mg IV metoclopramide,45,59 1 mg IV granisetron,5740 µg/kg granisetron,71 3 mg IV granisetron,75 and 1.25 mg IV droperidol88 as the other antiemetic. When evaluated as combination therapy, the 8-mg to 10-mg dexamethasone dose reduced early nausea (OR, 0.37; 95% CI, 0.23–0.60) but the clinical effect was not significant (NNT, 16.6; 95% CI, 10.1–20.8).

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Vomiting Od24 Hours

The effect of dexamethasone on vomiting over 24 hours by dosing groups is presented in Figure 6. Heterogeneity was low for both dose group comparisons (I2 = 0).

Figure 6
Figure 6
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The calculated NNT values for the combined effect of the 4-mg to 5-mg and 8-mg to 10-mg dose groups were 7.2 (95% CI, 5.5–10.7) and 6.9 (95% CI, 5.8–8.6), respectively. The funnel plot demonstrated some asymmetry (P = 0.04) for the 4-mg to 5-mg dose group and for the 8-mg to 10-mg dose group (P = 0.004). Five studies directly compared the effect of the 8-mg to 10-mg dose group with the 4-mg to 5-mg dose group on the incidence of vomiting over 24 hours.63,81,84,85,89 The combined effect showed a wide CI relative to a significant clinical benefit (OR, 0.64; 95% CI, 0.33–1.27).

Two studies evaluated the effect of the 4-mg to 5-mg dexamethasone dose when used with a second antiemetic;54,93 both studies did not demonstrate a beneficial effect of the 4-mg to 5-mg dexamethasone compared with the control group (P > 0.05). The studies used 2 mg IV haloperidol54 and 1 mg IV granisentron93 as the other antiemetic. Seven studies provided 7 comparisons of 8-mg to 10-mg dexamethasone dose used with a second antiemetic to reduce the incidence of vomiting over 24 hours.50,53,57,70,88,97,98 The effect of the 8-mg to 10-mg dexamethasone on the incidence of vomiting over 24 hours was significant when dexamethasone was examined with a second antiemetic (OR, 0.36; 95% CI, 0.21–0.61; NNT, 11.1; 95% CI, 7.5–21.2).The studies used 0.075 mg IV midazolam,50 4 mg IV ondansetron,53,97,98 1 mg IV granisetron,57 10 mg IV metoclopramide,59 50 mg per os dolasetron,70 and 1.25 mg IV droperidol88 as the other antiemetic.

The effect of dexamethasone on 24-hour incidence of vomiting was not significantly different for studies performed under general anesthesia (OR, 0.35; 95% CI, 0.17–0.73) compared with studies performed under regional/local anesthesia (OR, 0.33; 95% CI, 0.26–0.42; P = 0.17).

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Early (0–6 Hours) Vomiting

The effect of dexamethasone on early vomiting by dosing groups is presented in Figure 7. Heterogeneity was low for both dose group comparisons (I2 = 0). The calculated NNT values for the aggregated effect of the 4-mg to 5-mg and the 8-mg to 10-mg dose groups were 17.5 (95% CI, 9.8–90.9) and 16.9 (95% CI, 12.5–25.6), respectively. The funnel plot did not demonstrate asymmetry (P = 0.48) for the 4-mg to 5-mg dose, but it showed some asymmetry for the 8-mg to 10-mg dose (P = 0.04).

Figure 7
Figure 7
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Postoperative Need for Rescue Antiemetics (24 Hours)

The effect of dexamethasone on the 24-hour need for postoperative antiemetics by dosing groups is presented in Figure 8. Heterogeneity was low for both dose group comparisons (I2 < 10%).

Figure 8
Figure 8
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The calculated NNT values for the combined effect of the 4-mg to 5-mg and the 8-mg to 10-mg dose groups were 4.6 (95% CI, 3.6–6.4) and 5.8 (95% CI, 4.5–8.3), respectively. The analysis for the 4-mg to 5-mg and the 8-mg to 10-mg doses were limited by asymmetric funnel plots, indicating the possibility of publication bias (P = 0.01 and P = 0.008, respectively).

Only 1 study evaluated the effect of the 4-mg to 5-mg dexamethasone when used with a second antiemetic (OR, 0.46; 95% CI, 0.20–1.11).54 The study used 2 mg IV haloperidol as the other antiemetic.54 Four studies provided 4 comparisons for the 8-mg to 10-mg dexamethasone dose group on the 24-hour need for rescue antiemetics.50,53,59,70 The effect of dexamethasone on the postoperative need for rescue antiemetics was detected when the 8-mg to 10-mg dexamethasone dose group was examined with a second antiemetic (OR, 0.31; 95% CI, 0.15–0.63; NNT, 8.8; 95% CI, 5.7–19.6). The studies used 0.075 mg IV midazolam,50 4 mg IV ondansetron,53 10 mg IV metoclopramide,59 and 50 mg per os dolasetron70 as the other antiemetic.

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Early Postoperative Need for Rescue Antiemetics (0–6 Hours)

The effect of dexamethasone on the early (≤6 hours) need for postoperative antiemetics by dosing groups is presented in Figure 9. Heterogeneity was low for both dose group comparisons (I2 = 0). The calculated NNT values for the aggregated effect of the 4-mg to 5-mg and the 8-mg to 10-mg dose groups on the need for early rescue antiemetics were 9.4 (95% CI, 4.2–41.6) and 13.3 (95% CI, 8.7–27.0), respectively. The funnel plot did not demonstrate asymmetry for the 4-mg to 5-mg dose group (P = 0.06), but it did for the 8-mg to 10-mg dose group (P = 0.03).

Figure 9
Figure 9
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DISCUSSION

Several important findings have emerged from this current meta-analysis on the effect of dexamethasone for the prevention of postoperative nausea and/or vomiting. Different from Karanicolas et al.,3 who detected dose effects of dexamethasone on the incidence of PONV, we did not observe a clinical advantage of the 8-mg to 10-mg systemic dexamethasone dose compared with the 4-mg to 5-mg dose in the prevention of PONV. In addition, when used with a second antiemetic, the 4-mg to 5-mg dose of dexamethasone offered similar clinical benefits as the 8-mg to 10-mg dose, suggesting a lack of clinical advantage for the 8-mg to 10-mg dose. Our results support the SAMBA guidelines–recommended 4-mg to 5-mg dexamethasone dose for the prevention of PONV.1

There may be several reasons responsible for the different findings between the current meta-analysis and the one previously performed by Karanicolas et al.3 First, Karanicolas et al. arbitrarily compared a 2-mg to 5-mg dose group with an 8-mg to 16-mg dose group, while we based our group analysis on the SAMBA guidelines–recommended dexamethasone dose. Second, we excluded studies performed by the author Yoshitaka Fujii as suggested by Carlisle.5 Last, we examined a much larger number of patients, undergoing different surgical procedures, whereas Karanicolas et al.3 only examined patients undergoing laparoscopic cholecystectomy. Nonetheless, we observed less heterogeneity in our comparisons than Karanicolas et al.3 observed in their study, suggesting the generalizability of our findings.

We did not observe differences in the clinical effect of dexamethasone on the prevention of nausea or vomiting when these outcomes were examined separately. In contrast, Tramèr and Walder99 reported greater antivomiting than antinausea properties of ondasentron, another commonly used medication to prevent PONV. Nevertheless, it seems that previous comparisons between these individual drugs did not show a significant benefit in favor of a specific drug.100

Others have performed systematic reviews on the effect of dexamethasone to prevent PONV. Henzi et al.2 did not examine the dose-dependent effects of dexamethasone on PONV. Karanicolas et al.3 showed differences in PONV reduction between extreme doses of dexamethasone (2–5 mg vs 8–16 mg) in patients undergoing laparoscopic cholecystectomy. However, some of the doses included in the group comparisons of Karanicolas et al.3 are rarely used by clinical practitioners. Our findings are more generalizable because we included a wide range of surgical procedures, and we performed group comparisons based on common dosages used by clinical practitioners. We also did not detect a clinical benefit of the 8-mg to 10-mg dose compared with the 4-mg to 5-mg dose on the reduction of PONV when dexamethasone was used with a second antiemetic.

Our study is only valid when interpreted according to its limitations. To generalize our findings, we included several types of surgical procedures, allowing the possibility for a greater degree of heterogeneity. However, heterogeneity was low for the vast majority comparisons, which in fact suggests a generalizable effect of dexamethasone to prevent PONV. The funnel plots demonstrated asymmetry for some of the primary analysis involving the 8-mg to 10-mg dose group. The detection of negative studies that were not published due to negative results could decrease the combined effect for the 8-mg to 10-mg dose group in the affected comparisons.101

In summary, we demonstrated that when given as a single drug or when used in combination therapy, 4 mg to 5 mg of dexamethasone seems to have comparable clinical effects on the prevention of PONV as the 8-mg to 10-mg dose. Our findings confirm the recommendation of the SAMBA guidelines for the prevention of PONV, which favors the 4-mg to 5-mg dexamethasone dose.

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DISCLOSURES

Name: Gildasio S. De Oliveira Jr., MD, MSCI.

Contribution: This author helped design and conduct the study, analyze the data, and prepare the manuscript.

Attestation: This author attests to the integrity of the data.

Name: Lucas J. Santana Castro-Alves, MD.

Contribution: This author helped conduct the study and prepare the manuscript.

Name: Shireen Ahmad, MD.

Contribution: This author helped conduct the study and prepare the manuscript.

Name: Mark C. Kendall, MD.

Contribution: This author helped conduct the study and prepare the manuscript.

Name: Robert J. McCarthy, PharmD.

Contribution: This author helped conduct the study, analyze the data, and prepare the manuscript.

Attestation: This author attests to the integrity of the data.

This manuscript was handled by: Peter S. A. Glass, MB, ChB.

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REFERENCES

1. Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, Hooper VD, Kovac AL, Kranke P, Myles P, Philip BK, Samsa G, Sessler DI, Temo J, Tramèr MR, Vander Kolk C, Watcha MSociety for Ambulatory Anesthesia. . Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2007;105:1615–28

2. Henzi I, Walder B, Tramèr MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg. 2000;90:186–94

3. Karanicolas PJ, Smith SE, Kanbur B, Davies E, Guyatt GH. The impact of prophylactic dexamethasone on nausea and vomiting after laparoscopic cholecystectomy: a systematic review and meta-analysis. Ann Surg. 2008;248:751–62

4. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1–34

5. Carlisle JB. The analysis of 169 randomised controlled trials to test data integrity. Anaesthesia. 2012.

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

7. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13

8. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88

9. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34

10. Arslan M, Demir ME. Prevention of postoperative nausea and vomiting with a small dose of propofol combined with dexamethasone 4 mg or dexamethasone 8 mg in patients undergoing middle ear surgery: a prospective, randomized, double-blind study. Bratisl Lek Listy. 2011;112:332–6

11. D’souza N, Swami M, Bhagwat S. Comparative study of dexamethasone and ondansetron for prophylaxis of postoperative nausea and vomiting in laparoscopic gynecologic surgery. Int J Gynaecol Obstet. 2011;113:124–7

12. Pan PH, Lee SC, Harris LC. Antiemetic prophylaxis for postdischarge nausea and vomiting and impact on functional quality of living during recovery in patients with high emetic risks: a prospective, randomized, double-blind comparison of two prophylactic antiemetic regimens. Anesth Analg. 2008;107:429–38

13. Bano F, Zafar S, Aftab S, Haider S. Dexamethasone plus ondansetron for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a comparison with dexamethasone alone. J Coll Physicians Surg Pak. 2008;18:265–9

14. Tiippana E, Bachmann M, Kalso E, Pere P. Effect of paracetamol and coxib with or without dexamethasone after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2008;52:673–80

15. Antonetti M, Kirton O, Bui P, Ademi A, Staff I, Hudson-Civetta JA, Lilly R. The effects of preoperative rofecoxib, metoclopramide, dexamethasone, and ondansetron on postoperative pain and nausea in patients undergoing elective laparoscopic cholecystectomy. Surg Endosc. 2007;21:1855–61

16. Maddali MM, Mathew J, Fahr J, Zarroug AW. Postoperative nausea and vomiting in diagnostic gynaecological laparoscopic procedures: comparison of the efficacy of the combination of dexamethasone and metoclopramide with that of dexamethasone and ondansetron. J Postgrad Med. 2003;49:302–6

17. Pueyo FJ, López-Olaondo L, Sanchez-Ledesma MJ, Ortega A, Carrascosa F. Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting. Br J Anaesth. 2003;91:589–92

18. Szarvas S, Chellapuri RS, Harmon DC, Owens J, Murphy D, Shorten GD. A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery. Anesth Analg. 2003;97:259–63

19. Sanchez-Ledesma MJ, López-Olaondo L, Pueyo FJ, Carrascosa F, Ortega A. A comparison of three antiemetic combinations for the prevention of postoperative nausea and vomiting. Anesth Analg. 2002;95:1590–5

20. Kathirvel S, Dash HH, Bhatia A, Subramaniam B, Prakash A, Shenoy S. Effect of prophylactic ondansetron on postoperative nausea and vomiting after elective craniotomy. J Neurosurg Anesthesiol. 2001;13:207–12

21. Rothenberg DM, McCarthy RJ, Peng CC, Normoyle DA. Nausea and vomiting after dexamethasone versus droperidol following outpatient laparoscopy with a propofol-based general anesthetic. Acta Anaesthesiol Scand. 1998;42:637–42

22. Feroci F, Rettori M, Borrelli A, Lenzi E, Ottaviano A, Scatizzi M. Dexamethasone prophylaxis before thyroidectomy to reduce postoperative nausea, pain, and vocal dysfunction: a randomized clinical controlled trial. Head Neck. 2011;33:840–6

23. Leksowski K, Peryga P, Szyca R. Ondansetron, metoclopramid, dexamethason, and their combinations compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc. 2006;20:878–82

24. Ahn JH, Kim MR, Kim KH. Effect of i.v. dexamethasone on postoperative dizziness, nausea and pain during canal wall-up mastoidectomy. Acta Otolaryngol. 2005;125:1176–9

25. Liu K, Hsu CC, Chia YY. The effect of dose of dexamethasone for antiemesis after major gynecological surgery. Anesth Analg. 1999;89:1316–8

26. Song JW, Park EY, Lee JG, Park YS, Kang BC, Shim YH. The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl-based intravenous patient-controlled analgesia. Anaesthesia. 2011;66:263–7

27. Nazar CE, Lacassie HJ, López RA, Muñoz HR. Dexamethasone for postoperative nausea and vomiting prophylaxis: effect on glycaemia in obese patients with impaired glucose tolerance. Eur J Anaesthesiol. 2009;26:318–21

28. Worni M, Schudel HH, Seifert E, Inglin R, Hagemann M, Vorburger SA, Candinas D. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg. 2008;248:1060–6

29. Kirdak T, Yilmazlar A, Cavun S, Ercan I, Yilmazlar T. Does single, low-dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double-blind, randomized clinical trial. Am Surg. 2008;74:160–7

30. Laiq N, Khan MN, Qureshi FA, Khan S, Jan AS. Dexamethasone as antiemetic during gynaecological laparoscopic surgery. J Coll Physicians Surg Pak. 2005;15:778–81

31. Al-Shehri AM. Steroidtherapy for post-tonsillectomy symptoms in adults: a randomized, placebo-controlled study. Ann Saudi Med. 2004;24:365–7

32. Sahjpaul RL, Mahon J, Wiebe S. Dexamethasone for morbidity after subdural electrode insertion–a randomized controlled trial. Can J Neurol Sci. 2003;30:340–8

33. Halvorsen P, Raeder J, White PF, Almdahl SM, Nordstrand K, Saatvedt K, Veel T. The effect of dexamethasone on side effects after coronary revascularization procedures. Anesth Analg. 2003;96:1578–83

34. De Oliveira GS Jr, Ahmad S, Fitzgerald PC, Marcus RJ, Altman CS, Panjwani AS, McCarthy RJ. Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery. Br J Anaesth. 2011;107:362–71

35. Movafegh A, Soroush AR, Navi A, Sadeghi M, Esfehani F, Akbarian-Tefaghi N. The effect of intravenous administration of dexamethasone on postoperative pain, nausea, and vomiting after intrathecal injection of meperidine. Anesth Analg. 2007;104:987–9

36. Mendes MN, Monteiro Rde S, Martins FA. [Prophylaxis of postoperative nausea and vomiting in morbidly obese patients undergoing laparoscopic gastroplasties: a comparative study among three methods]. Rev Bras Anestesiol. 2009;59:570–6

37. Kardash KJ, Sarrazin F, Tessler MJ, Velly AM. Single-dose dexamethasone reduces dynamic pain after total hip arthroplasty. Anesth Analg. 2008;106:1253–7 table of contents

38. McKenzie R, Riley TJ, Tantisira B, Hamilton DL. Effect of propofol for induction and ondansetron with or without dexamethasone for the prevention of nausea and vomiting after major gynecologic surgery. J Clin Anesth. 1997;9:15–20

39. Murphy GS, Szokol JW, Greenberg SB, Avram MJ, Vender JS, Nisman M, Vaughn J. Preoperative dexamethasone enhances quality of recovery after laparoscopic cholecystectomy: effect on in-hospital and postdischarge recovery outcomes. Anesthesiology. 2011;114:882–90

40. Mathiesen O, Jørgensen DG, Hilsted KL, Trolle W, Stjernholm P, Christiansen H, Hjortsø NC, Dahl JB. Pregabalin and dexamethasone improves post-operative pain treatment after tonsillectomy. Acta Anaesthesiol Scand. 2011;55:297–305

41. Gómez-Hernández J, Orozco-Alatorre AL, Domínguez-Contreras M, Oceguera-Villanueva A, Gómez-Romo S, Alvarez Villaseñor AS, Fuentes-Orozco C, González-Ojeda A. Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer. BMC Cancer. 2010;10:692

42. Sánchez-Rodríguez PE, Fuentes-Orozco C, González-Ojeda A. Effect of dexamethasone on postoperative symptoms in patients undergoing elective laparoscopic cholecystectomy: randomized clinical trial. World J Surg. 2010;34:895–900

43. Thangaswamy CR, Rewari V, Trikha A, Dehran M, Chandralekha. Dexamethasone before total laparoscopic hysterectomy: a randomized controlled dose-response study. J Anesth. 2010;24:24–30

44. Mattila K, Kontinen VK, Kalso E, Hynynen MJ. Dexamethasone decreases oxycodone consumption following osteotomy of the first metatarsal bone: a randomized controlled trial in day surgery. Acta Anaesthesiol Scand. 2010;54:268–76

45. Entezariasl M, Khoshbaten M, Isazadehfar K, Akhavanakbari G. Efficacy of metoclopramide and dexamethasone for postoperative nausea and vomiting: a double-blind clinical trial. East Mediterr Health J. 2010;16:300–3

46. Alghanem SM, Massad IM, Rashed EM, Abu-Ali HM, Daradkeh SS. Optimization of anesthesia antiemetic measures versus combination therapy using dexamethasone or ondansetron for the prevention of postoperative nausea and vomiting. Surg Endosc. 2010;24:353–8

47. Sistla S, Rajesh R, Sadasivan J, Kundra P, Sistla S. Does single-dose preoperative dexamethasone minimize stress response and improve recovery after laparoscopic cholecystectomy? Surg Laparosc Endosc Percutan Tech. 2009;19:506–10

48. Wu JI, Lu SF, Chia YY, Yang LC, Fong WP, Tan PH. Sevoflurane with or without antiemetic prophylaxis of dexamethasone in spontaneously breathing patients undergoing outpatient anorectal surgery. J Clin Anesth. 2009;21:469–73

49. Yeo J, Jung J, Ryu T, Jeon YH, Kim S, Baek W. Antiemetic efficacy of dexamethasone combined with midazolam after middle ear surgery. Otolaryngol Head Neck Surg. 2009;141:684–8

50. Makhdoom NK, Farid MF. Prophylactic antiemetic effects of midazolam, dexamethasone, and its combination after middle ear surgery. Saudi Med J. 2009;30:504–8

51. Fukami Y, Terasaki M, Okamoto Y, Sakaguchi K, Murata T, Ohkubo M, Nishimae K. Efficacy of preoperative dexamethasone in patients with laparoscopic cholecystectomy: a prospective randomized double-blind study. J Hepatobiliary Pancreat Surg. 2009;16:367–71

52. Mathiesen O, Jacobsen LS, Holm HE, Randall S, Adamiec-Malmstroem L, Graungaard BK, Holst PE, Hilsted KL, Dahl JB. Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty. Br J Anaesth. 2008;101:535–41

53. Gautam B, Shrestha BR, Lama P, Rai S. Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy. Kathmandu Univ Med J (KUMJ). 2008;6:319–28

54. Chu CC, Shieh JP, Tzeng JI, Chen JY, Lee Y, Ho ST, Wang JJ. The prophylactic effect of haloperidol plus dexamethasone on postoperative nausea and vomiting in patients undergoing laparoscopically assisted vaginal hysterectomy. Anesth Analg. 2008;106:1402–6

55. Erhan Y, Erhan E, Aydede H, Yumus O, Yentur A. Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: A randomized placebo-controlled study. Surg Endosc. 2008;22:1487–92

56. Koç S, Memis D, Sut N. The preoperative use of gabapentin, dexamethasone, and their combination in varicocele surgery: a randomized controlled trial. Anesth Analg. 2007;105:1137–42

57. Moussa AA, Oregan PJ. Prevention of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery–granisetron alone vs granisetron combined with dexamethasone/droperidol. Middle East J Anesthesiol. 2007;19:357–67

58. Bianchin A, De Luca A, Caminiti A. Postoperative vomiting reduction after laparoscopic cholecystectomy with single dose of dexamethasone. Minerva Anestesiol. 2007;73:343–6

59. Nesek-Adam V, Grizelj-Stojcic E, Rasic Z, Cala Z, Mrsic V, Smiljanic A. Comparison of dexamethasone, metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Surg Endosc. 2007;21:607–12

60. Wu JI, Lo Y, Chia YY, Liu K, Fong WP, Yang LC, Tan PH. Prevention of postoperative nausea and vomiting after intrathecal morphine for Cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination. Int J Obstet Anesth. 2007;16:122–7

61. Kashmiri ZA, Sheikh Z, Haider S. Injection dexamethasone in preventing postoperative nausea and vomiting: a comparison with placebo in the patients undergoing laparoscopic cholecystectomy. J Coll Physicians Surg Pak. 2006;16:689–92

62. Chen MS, Hong CL, Chung HS, Tan PP, Tsai CC, Su HH, Wong CH. Dexamethasone effectively reduces postoperative nausea and vomiting in a general surgical adult patient population. Chang Gung Med J. 2006;29:175–81

63. Numazaki M, Fujii Y. Reduction of postoperative emetic episodes and analgesic requirements with dexamethasone in patients scheduled for dental surgery. J Clin Anesth. 2005;17:182–6

64. McKean S, Kochilas X, Kelleher R, Dockery M. Use of intravenous steroids at induction of anaesthesia for adult tonsillectomy to reduce post-operative nausea and vomiting and pain: a double-blind randomized controlled trial. Clin Otolaryngol. 2006;31:36–40

65. Feo CV, Sortini D, Ragazzi R, De Palma M, Liboni A. Randomized clinical trial of the effect of preoperative dexamethasone on nausea and vomiting after laparoscopic cholecystectomy. Br J Surg. 2006;93:295–9

66. Laiq N, Khan MN, Qureshi FA, Khan S, Jan AS. Dexamethasone as antiemetic during gynaecological laparoscopic surgery. J Coll Physicians Surg Pak. 2005;15:778––81

67. Yuksek MS, Alici HA, Erdem AF, Cesur M. Comparison of prophylactic anti-emetic effects of ondansetron and dexamethasone in women undergoing day-case gynaecological laparoscopic surgery. J Int Med Res. 2003;31:481–8

68. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial. Ann Surg. 2003;238:651–60

69. Nortcliffe SA, Shah J, Buggy DJ. Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo. Br J Anaesth. 2003;90:665–70

70. Piper SN, Triem JG, Röhm KD, Kranke P, Maleck WH, Boldt J. [Prevention of post-operative nausea and vomiting. Randomised comparison of dolasetron versus dolasetron plus dexamethasone]. Anaesthesist. 2003;52:120–6

71. Biswas BN, Rudra A. Comparison of granisetron and granisetron plus dexamethasone for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2003;47:79–83

72. Elhakim M, Nafie M, Mahmoud K, Atef A. Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy. Can J Anaesth. 2002;49:922–6

73. Wang JJ, Wang PC, Liu YH, Chien CC. Low-dose dexamethasone reduces nausea and vomiting after tympanomastoid surgery: a comparison of tropisetron with saline. Am J Otolaryngol. 2002;23:267–71

74. Coloma M, White PF, Markowitz SD, Whitten CW, Macaluso AR, Berrisford SB, Thornton KC. Dexamethasone in combination with dolasetron for prophylaxis in the ambulatory setting: effect on outcome after laparoscopic cholecystectomy. Anesthesiology. 2002;96:1346–50

75. Goksu S, Kocoglu H, Bayazit YA, Yüksek S, Karci Y, Kanlikama M, Oner U. Antiemetic effects of granisetron, droperidol and dexamethasone in otologic surgery. Auris Nasus Larynx. 2002;29:253–6

76. Wang JJ, Ho ST, Uen YH, Lin MT, Chen KT, Huang JC, Tzeng JI. Small-dose dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy: a comparison of tropisetron with saline. Anesth Analg. 2002;95:229–32

77. Tzeng JI, Hsing CH, Chu CC, Chen YH, Wang JJ. Low-dose dexamethasone reduces nausea and vomiting after epidural morphine: a comparison of metoclopramide with saline. J Clin Anesth. 2002;14:19–23

78. Wang JJ, Tzeng JI, Ho ST, Chen JY, Chu CC, So EC. The prophylactic effect of tropisetron on epidural morphine-related nausea and vomiting: a comparison of dexamethasone with saline. Anesth Analg. 2002;94:749–53

79. Tzeng JI, Wang JJ, Ho ST, Tang CS, Liu YC, Lee SC. Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post-Caesarean section analgesia: comparison of droperidol and saline. Br J Anaesth. 2000;85:865–8

80. Thomas R, Jones N. Prospective randomized, double-blind comparative study of dexamethasone, ondansetron, and ondansetron plus dexamethasone as prophylactic antiemetic therapy in patients undergoing day-case gynaecological surgery. Br J Anaesth. 2001;87:588–92

81. Lee Y, Lin PC, Lai HY, Huang SJ, Lin YS, Cheng CR. Prevention of PONV with dexamethasone in female patients undergoing desflurane anesthesia for thyroidectomy. Acta Anaesthesiol Sin. 2001;39:151–6

82. Huang JC, Shieh JP, Tang CS, Tzeng JI, Chu KS, Wang JJ. Low-dose dexamethasone effectively prevents postoperative nausea and vomiting after ambulatory laparoscopic surgery. Can J Anaesth. 2001;48:973–7

83. Liu YH, Li MJ, Wang PC, Ho ST, Chang CF, Ho CM, Wang JJ. Use of dexamethasone on the prophylaxis of nausea and vomiting after tympanomastoid surgery. Laryngoscope. 2001;111:1271–4

84. Ho S, Wang JJ, Tzeng JI, Liu HS, Ger LP, Liaw WJ. Dexamethasone for preventing nausea and vomiting associated with epidural morphine: a dose-ranging study. Anesth Analg. 2001;92:745––8

85. Wang JJ, Ho ST, Wong CS, Tzeng JI, Liu HS, Ger LP. Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-Cesarean analgesia. Can J Anaesth. 2001;48:185–90

86. Tan PH, Liu K, Peng CH, Yang LC, Lin CR, Lu CY. The effect of dexamethasone on postoperative pain and emesis after intrathecal neostigmine. Anesth Analg. 2001;92:228–32

87. Coloma M, Duffy LL, White PF, Kendall Tongier W, Huber PJ Jr. Dexamethasone facilitates discharge after outpatient anorectal surgery. Anesth Analg. 2001;92:85–8

88. Tzeng JI, Tswei TS, Tang CS, Ho ST, Wang JJ. Dexamethasone alone does not prevent postoperative nausea and vomiting in women undergoing dilatation and curettage: a comparison with droperidol and saline. Acta Anaesthesiol Sin. 2000;38:137–42

89. Wang JJ, Ho ST, Lee SC, Liu YC, Ho CM. The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study. Anesth Analg. 2000;91:1404–7

90. Wang JJ, Ho ST, Tzeng JI, Tang CS. The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg. 2000;91:136–9

91. Wang JJ, Ho ST, Liu HS, Ho CM. Prophylactic antiemetic effect of dexamethasone in women undergoing ambulatory laparoscopic surgery. Br J Anaesth. 2000;84:459–62

92. Wang JJ, Ho ST, Liu YH, Lee SC, Liu YC, Liao YC, Ho CM. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth. 1999;83:772–5

93. Janknegt R, Pinckaers JW, Rohof MH, Ausems ME, Arbouw ME, van der Velden RW, Brouwers JR. Double-blind comparative study of droperidol, granisetron and granisetron plus dexamethasone as prophylactic anti-emetic therapy in patients undergoing abdominal, gynaecological, breast or otolaryngological surgery. Anaesthesia. 1999;54:1059–68

94. Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH, Liao YC. The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy: a comparison of droperidol with saline. Anesth Analg. 1999;89:200–3

95. Wang JJ, Ho ST, Liu YH, Ho CM, Liu K, Chia YY. Dexamethasone decreases epidural morphine-related nausea and vomiting. Anesth Analg. 1999;89:117–20

96. Rajeeva V, Bhardwaj N, Batra YK, Dhaliwal LK. Comparison of ondansetron with ondansetron and dexamethasone in prevention of PONV in diagnostic laparoscopy. Can J Anaesth. 1999;46:40–4

97. López-Olaondo L, Carrascosa F, Pueyo FJ, Monedero P, Busto N, Sáez A. Combination of ondansetron and dexamethasone in the prophylaxis of postoperative nausea and vomiting. Br J Anaesth. 1996;76:835–40

98. McKenzie R, Tantisira B, Karambelkar DJ, Riley TJ, Abdelhady H. Comparison of ondansetron with ondansetron plus dexamethasone in the prevention of postoperative nausea and vomiting. Anesth Analg. 1994;79:961–4

99. Tramèr MR, Walder B. Efficacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia therapy: a quantitative systematic review. Anesth Analg. 1999;88:1354–61

100. Carlisle JB, Stevenson CA. Drugs for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2006:CD004125

101. De Oliveira GS Jr, Chang R, Kendall MC, Fitzgerald PC, McCarthy RJ. Publication bias in the anesthesiology literature. Anesth Analg. 2012;114:1042––8

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