Effects of single dose, postinduction dexamethasone on recovery after cardiac surgery.
BACKGROUND
Corticosteroids have been recommended to facilitate rapid recovery after cardiac surgery. We previously reported that dexamethasone given after induction of anesthesia decreases the incidence of postoperative shivering. We performed a post hoc analysis of the data obtained during that study, focusing on secondary outcomes.


METHODS
A total of 235 adult patients undergoing elective coronary or valvular heart surgery were randomized to receive dexamethasone 0.6 mg/kg or placebo after induction of anesthesia. Patients who had pharmacologically treated diabetes mellitus, had hypersensitivity to dexamethasone, or were receiving treatment with corticosteroids were excluded.


RESULTS
We found that, compared with placebo, patients receiving dexamethasone were more likely to remain tracheally intubated for 6 hours or less (26.4% vs 10.0%, p = 0.020) and had a lower incidence of early postoperative fever (20.2% vs 36.8%, p = 0.009) and new-onset atrial fibrillation during the first 3 days postoperatively (18.9% vs 32.3%, p = 0.027). However, we could not demonstrate a statistical difference in the intensive care unit or hospital length of stay, or in overall morbidity and mortality. The dexamethasone-treated patients were also more likely to have a higher blood glucose on admission to the intensive care unit (186 mg/dL vs 143 mg/dL, p = 0.012).


CONCLUSIONS
Dexamethasone facilitates early tracheal extubation and is associated with a lower incidence of early postoperative fever and new-onset atrial fibrillation. Apart from a treatable decreased glucose tolerance, dexamethasone treatment was not shown to affect morbidity or mortality significantly.
Yared
J P
JP
Department of Cardiothoracic Anesthesiology, The Cleveland Clinic Foundation, Ohio 44195, USA. yaredj@cesmtp.ccf.org
Starr
N J
NJ
Torres
F K
FK
Bashour
C A
CA
Bourdakos
G
G
Piedmonte
M
M
Michener
J A
JA
Davis
J A
JA
Rosenberger
T E
TE
D000758:Anesthesia; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000517:prevention & control; D001786:Blood Glucose / Q000032:analysis; D006348:Cardiac Surgical Procedures; D003907:Dexamethasone / Q000008:administration & dosage*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D003907:Dexamethasone