Dexamethasone對女性患者在接受Desflurane麻醉及甲狀腺切除術後預防噁心及嘔吐的效果

Prevention of PONV with Dexamethasone in Female Patients undergoing Desflurane Anesthesia for Thyroidectomy

背景：報告顯示病人使用desflurane麻醉後，比使用isoflurane或sevoflurane有較高的比率會產生噁心和嘔吐。先前研究證明給予dexamethasone於使用isoflurane麻醉進行甲狀腺切除術的女性患者，其預防噁心嘔吐的最低有效劑量為5毫克。本研究觀察麻醉誘導前給予dexamethasone 8毫克，5毫克以及生理食鹽水，在女性患者使用desflurane麻醉進行甲狀腺切除術後，對於噁心嘔吐的預防效果。方法：一百三十五名預備進行甲狀腺切除術的女性病人隨機分成三組。於麻醉誘導前分別靜脈給予dexamethasone 8毫克（D8組），dexamethasone 5毫克（D5組），和生理食鹽水（S組）。結果：Dexamethasone 8毫克及5毫克都可以降低術後噁心嘔吐以及使用止吐劑的機率，然而D8和D5組互相比較時，術前使用dexamethasone 8毫克的病人在術後24小時內不發生嘔吐及不需接受止吐劑的比率比使用dexamethasone 5毫克的病人高(86% vs. 67%; P<0.01)。結論：對於使用desflurane麻醉進行甲狀腺切除術的女性病人，於麻醉誘導前靜脈給予dexamethasone 8毫克，可以提供比dexamethasone 5毫克更有效的預防術後噁心嘔吐的效果。

Background: Desflurane is associated with a higher incidence of 24-h postoperative nausea and vomiting (PONV) as compared with sevoflurane or isoflurane. Dexamethasone 5 mg i.v. is suggested to be the minimum effective dose for prophylaxis of PONV in women undergoing thyroidectomy with isoflurane anesthesia. The objective of this sudty was to investigate whether a 5 mg dose of dexamethasone could be enough for, or a larger dose at 8 mg, could be more capable of preveting PONV in women undergoing desflurane anesthesia for thyroidectomy. Methods: One hundred and thirty five patients were assigned to receive one of three treatment regimens prior to induction i.e., dexamethasone 8 mg i.v. (Group D8), dexamethesone 5 mg i.v. (Group D5) or saline (Group S). Results: It was demonstrated that the prophylactic administration of either dexamethasone 8 mg or 5 mg significantly reduced the overall incidence of PONV in patients undergoing thyroidectomy with desflurane anesthesia (P< 0.001, Group D8 vs. Group S; Group D5 vs. Group S). However, patients who received dexamethasone 8 mg showed a higher incidence of complete responses (no vomiting or need of rescue antiemetic medication for a 24-h postoperative period) in comparison with those receiving dexamethasone 5 mg (86% vs. 67%; P < 0.01). Conclusions: The results of this study showed that in PONV prophylaxis, in female patients undergoing desflurane anesthesia for thyroidectomy, the effect of dexamethasone 8 mg was superior to that of dexamethasone 5 mg.