Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki, Okayama, 710-8602, Japan.
Department of Emergency Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Fukui, Japan.
Can J Anaesth. 2019 May;66(5):562-575. doi: 10.1007/s12630-018-01288-2. Epub 2019 Jan 7.
Postoperative sore throat related to tracheal intubation negatively affects patient recovery and satisfaction. Previous reviews suggested that intravenous dexamethasone diminishes postoperative sore throat. Nevertheless, they comprised a small number of studies with inconsistencies in outcome reporting. We performed a systematic review and meta-analysis to assess the efficacy and safety of preoperative intravenous dexamethasone in preventing postoperative sore throat in adult patients.
We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to August 24, 2018. We included randomized-controlled trials that assessed the efficacy and safety of intravenous dexamethasone in adult surgical patients who required general anesthesia and endotracheal intubation. Our primary outcomes were the incidence and severity of sore throat at 24 hr after surgery/extubation and adverse events. We pooled the data using a random-effects model. We conducted a trial sequential analysis (TSA) on the incidence of sore throat.
We included 15 randomized-controlled trials involving 1,849 patients. In comparison with non-analgesic methods, intravenous dexamethasone was associated with a reduced incidence (risk ratio, 0.62; 95% confidence interval [CI], 0.51 to 0.75) and severity (standardized mean difference, - 1.06; 95% CI, - 1.80 to - 0.33) of postoperative sore throat. Serious adverse events were not associated with intravenous dexamethasone administration in the four studies where this was assessed. The TSA indicated that the evidence regarding the incidence of postoperative sore throat is adequate.
Our study indicates that preoperative intravenous administration of dexamethasone alleviates postoperative sore throat more effectively than non-analgesic methods.
PROSPERO (CRD42018086697); registered 29 January, 2018.
与气管插管相关的术后咽喉痛会影响患者的康复和满意度。先前的综述表明，静脉内给予地塞米松可减轻术后咽喉痛。然而，这些综述纳入的研究数量较少，且在结果报告方面存在不一致性。我们进行了一项系统评价和荟萃分析，以评估成年患者全身麻醉和气管插管后术前静脉内给予地塞米松预防术后咽喉痛的疗效和安全性。
我们检索了 PubMed、EMBASE 和 Cochrane 对照试验中心数据库，检索时间截至 2018 年 8 月 24 日。我们纳入了评估成年手术患者在全身麻醉和气管插管后使用地塞米松的疗效和安全性的随机对照试验。我们的主要结局是术后/拔管后 24 小时咽喉痛的发生率和严重程度以及不良事件。我们使用随机效应模型汇总数据。我们对咽喉痛的发生率进行了试验序贯分析（TSA）。
我们纳入了 15 项随机对照试验，共纳入 1849 例患者。与非镇痛方法相比，静脉内给予地塞米松可降低咽喉痛的发生率（风险比，0.62；95%置信区间[CI]，0.51 至 0.75）和严重程度（标准化均数差，-1.06；95%CI，-1.80 至-0.33）。在四项评估地塞米松相关严重不良事件的研究中，未发现静脉内给予地塞米松与严重不良事件相关。TSA 表明，关于术后咽喉痛发生率的证据是充分的。
我们的研究表明，术前静脉内给予地塞米松比非镇痛方法更有效地缓解术后咽喉痛。
PROSPERO（CRD42018086697）；注册日期 2018 年 1 月 29 日。
