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The influence of a prophylactic dose of dexamethasone for postoperative nausea and vomiting on plasma interleukin concentrations after laparoscopic cholecystectomy: A randomised trial

Ionescu, Daniela C.; Hadade, Adina I.; Mocan, Teodora A.; Margarit, Simona D.

European Journal of Anaesthesiology: April 2014 - Volume 31 - Issue 4 - p 204–211
doi: 10.1097/EJA.0b013e3283642a01
Pharmacology

BACKGROUND: Little is known about the effects of small doses of dexamethasone used for the prophylaxis of postoperative nausea and vomiting on the innate host response.

OBJECTIVES: We studied the influence of dexamethasone 4 mg on the perioperative plasma concentrations of interleukins after laparoscopic cholecystectomy. We hypothesised that there would be differences in pro-inflammatory interleukin concentrations in patients who received dexamethasone.

DESIGN: A randomised controlled study.

SETTING: University hospital.

PATIENTS: Forty-six patients undergoing laparoscopic cholecystectomy under total intravenous anaesthesia were allocated randomly into one of two study groups; 42 patients completed the study.

INTERVENTIONS: Patients in group 1 (dexamethasone, n = 22) received dexamethasone 4 mg and group 2 (n = 20) acted as controls.

MAIN OUTCOME MEASURES: Plasma levels of tumour necrosis factor alpha and interleukins 1β, 6, 8, 10 and 13 were measured before anaesthesia, before surgery and 2 and 24 h after surgery. The frequency and number of episodes of postoperative nausea and vomiting were recorded.

RESULTS: Areas under the curve of the percentage variation of interleukins 6 and 8 were significantly lower in the dexamethasone group. There were no significant differences between groups in the areas under the curve for tumour necrosis factor alpha and interleukins 1β, 10 and 13. The greatest variation in interleukin concentrations was 2 h postoperatively, when the concentration of interleukin 6 was greater in the control group, whereas the concentration of interleukin 10 was higher in the dexamethasone group. Twenty-four hours after surgery, only the concentration of interleukin 6 remained significantly increased in both groups (P = 0.001 and P = 0.002, respectively). There were no significant differences between groups in respect of postoperative nausea and vomiting.

CONCLUSION: Prophylactic dexamethasone given before laparoscopic cholecystectomy produced a significant decrease in concentrations of interleukins 6 and 8. Further studies are needed to investigate the clinical implications of these findings.

From the 1st Department of Anesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (DCI, SDM), Outcome Research Consortium, Cleveland, Ohio, USA (DCI), Department of Anesthesia and Intensive Care, Regional Institute of Gastroenterology and Hepatology ‘O Fodor’ (AIH), and Department of Physiology, Master in Medical Statistics and Bioinformatics, University of Medicine and Pharmacy ‘Iuliu Hatieganu’, Cluj-Napoca (TAM), Romania

Correspondence to Daniela C. Ionescu, MD, PhD, DEAA, Sectia ATI, Clinica Chirurgie III, Str. Croitorilor, nr 19-21, 400162 Cluj-Napoca, Romania E-mail: daniela_ionescu@umfcluj.ro

Published online 20 July 2013

© 2014 European Society of Anaesthesiology