title: Small-dose dexamethasone improves quality of recovery scores after elective cardiac surgery: a randomized, double-blind, placebo-controlled study.
abstract: OBJECTIVE
  The use of steroid therapy in cardiac surgical patients remains controversial. The aim of this clinical investigation was to determine the effect of small-dose dexamethasone therapy on patient-perceived quality of recovery (QoR) scores in elective cardiac surgical patients. In addition, the authors assessed the impact of dexamethasone on the incidence of common adverse events after cardiopulmonary bypass (CPB).
  
  
  METHODS
  A prospective, randomized study.
  
  
  METHODS
  University hospitals.
  
  
  METHODS
  One hundred seventeen patients undergoing cardiac surgery with CPB and anticipated early tracheal extubation.
  
  
  METHODS
  Subjects were randomized to receive either dexamethasone (dexamethasone group, 8 mg at the induction of anesthesia and at the initiation of CPB) or placebo (control group, saline).
  
  
  RESULTS
  The QoR was assessed using the QoR-40 scoring system preoperatively and on postoperative days (PODs) 1 and 2. Secondary outcome measures assessed in the postoperative period included nausea, vomiting, fatigue, febrile responses, shivering, pulmonary gas exchange, and analgesic requirements. Global QoR-40 scores (median [range]) were higher in the dexamethasone group compared with the control group on POD 1 (167 [133-192] v 157 [108-195]; p < 0.0001) and POD 2 (173 [140-196] v 166 [122-196]; p = 0.001). In the dexamethasone group, improved QoR was observed in the QoR-40 dimensions of emotional state (p = 0.002), physical comfort (p = 0.0001-0.006), and pain (p < 0.0001). The incidences or severity of postoperative fatigue (p < 0.0001), febrile responses (p < 0.0001), and shivering (p = 0.001) were reduced in the dexamethasone group.
  
  
  CONCLUSIONS
  Patient-perceived postoperative QoR in cardiac surgical patients is enhanced significantly by small-dose dexamethasone treatment.
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, IL 60201, USA. dgmurphy2@yahoo.com
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Murphy
authors.forename: Saadia S
authors.initials: SS
authors.lastname: Sherwani
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Szokol
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Avram
authors.forename: Steven B
authors.initials: SB
authors.lastname: Greenberg
authors.forename: Kinjal M
authors.initials: KM
authors.lastname: Patel
authors.forename: Leonard D
authors.initials: LD
authors.lastname: Wade
authors.forename: Jessica
authors.initials: J
authors.lastname: Vaughn
authors.forename: Jayla
authors.initials: J
authors.lastname: Gray
mesh_terms: D000368:Aged; D000758:Anesthesia; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001784:Blood Gas Analysis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use*; D004311:Double-Blind Method; D005221:Fatigue / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control; D011788:Quality of Life; D020127:Recovery of Function; D056346:Sternotomy
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone