Objective: To study the efficacy of single dose of preoperative dexamethasone in the  prevention of  postoperative  nausea  and  vomiting  in  patients  undergoing laparoscopic  cholecystectomy.

Materials and Methods: 110 patients were randomized in two equal groups. Each of the groups received either 2ml (8mg) intravenous dexamethasone (Group A) or 2ml intravenous normal saline as placebo (Group B).

Results:  6  patients (14.5%) in  group A and 19 patients (34.5%) in  group B had postoperative nausea  and vomiting in first 6 hours whereas  2  patients (3.6%) in group A and 5 patients (9.0%) in  group B had postoperative nausea  and vomiting in  6-24  hours.

Conclusion: Preoperative dexamethasone improves the surgical outcome by reducing disabling symptoms of nausea and vomiting without apparent side-effects. So we suggest that single dose of preoperative dexamethasone should be used as a routine in patients undergoing elective laparoscopic cholecystectomy.

Keywords:  Cholelithiasis, Dexamethasone, Laparoscopic cholecystectomy, Postoperative nausea and vomiting.

1. Madsen MR, Jensen KE. Postoperative pain and nausea after laparoscopic cholecystectomy. Surg Laparosc Endosc. 1992;2:303-5.                
2. Apfel CC, Laara E, Koivuranta M, Greim C-A, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91:693-700.
3. Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs. 2000;59:213-43.       
4. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Factors determining conval-escence after uncomplicated laparoscopic cholecystectomy. Arch Surg. 2001; 136:917-21.   
5. Watcha M F, White PF. Postoperative nausea and vomiting; its etiology, prevention  and  treetment .Anesthesiology 1992;77:162-84.
6. Ashfaque M. Prevention of postoperative nausea and vomiting:a review of causative factors and management. Med Channel 1998; 4:43-52.
7. Wang JJ, Ho ST, Liu YH, et al. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystec-tomy. Br J Anaesth 1999;83:772–5.
8. Wang JJ, Ho ST, Lee SC, et al. The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study. AnesthAnalg 2000;91:1404–7.
9. Sehine I, Nishiwaki Y, Kakinuma R, et al. Phase II study of high-dose dexamethasone-based association in acute and delayed high-dose cisplatin-induced emesis: study 9413. Br J Cancer 1997; 76:90–2.
10. Fujii Y. The utility of antiemetics in the prevention and treatment of postoperative nausea and vomiting in patients scheduled for laparoscopic cholecystectomy. Curr Pharm Des. 2005;11:3173-83.   
11. Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg. 2000;90:186-94.    
12. 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 cholecys-tectomy. Can J Anaesth. 2002;49:922-6.
13. Aapro MS, Alberts DS. Dexamethasone as an antiemetic in patients treated with cisplatin. N Engl J Med 1981; 305: 520.
14. Asad Ali Shah, Atif Pervez, Azhar Bashir. Role of Dexamethasone in Postoperative Nausea and Vomiting in Laparoscopic Cholecystectomy. P J M H S 2011;5: 1: 89.
15. Amer Riaz Bhutta , Bahzad Akram , Azhar Bashir , Atif Pervez , Ejaz Iqbal, Fara Hassan , Muhammad Arshad Cheema. Preoperative Dexamethasone Reduces Nausea and Vomiting After Laparoscopic Cholecystectomy. P J M H S 2012;6 (3): 699
16. J. wang, S.T.Ho, Y, H. Liu, S. C Lee, Y. C. Liu, Y. C. Liao, C. M. Ho. Dexamet-hasone reduces nausea and vomiting after laparoscopic cholecystectomy. British Journal of anesthesia .1999;83(5):772-5.
17. Ahmadreza Mohtadi , Sholeh Nesioonpour , Amir Salari , Reza Akhondzadeh , Babak Masood Rad, Seyed Mohammad Mehdi Aslani ,The Effect of Single-Dose Administration of Dexamethasone on Postoperative Pain in Patients Undergoing Laparoscopic CholecystectomyAnesth Pain Med. 2014 August; 4(3): e17872.
18. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improvees surgical outcome after laparos-copic cholecystectomy-a randomized double blind placebo controlled trial. Ann Surg 2003;238:651-60.
19. 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.         
20. Ionescu D, Mitre C, Leuke L, Bertianu C, Paskarenko G, Puia C, et al. Procedures for preventing postoperative nausea and vomiting after laparoscopic cholecys-tectomy: dexamethasone and ondansetron. AnesteziolReanimatol2007; 2: 50-2.
21. 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.
22. Wakasugi M,  Tori M,  Shimizu J,  Kim YK,  Noda T, Dono K, Takeda Y, Yamamoto T, Oshima S, Morimoto Y, Asaoka T, Eguchi H, Nagano H, Mori M, Doki Y;  Efficacy of preoperative dexamethasone for postoperative nausea and vomiting after laparoscopic cholecystectomy: a large-scale, multicenter, randomized, double-blind, placebo-controlled trial in Japan. J Hepatobiliary Pancreat Sci.2015: Nov; 22(11):802-9.

Dr Gopal Krishan

Assistant Professor, Department of Anaesthesiology, RMCH Bareilly, UP, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Telephone No.:8979341741