[Influence of dexamethasone on the incidence of postoperative nausea and vomiting in breast cancer patients with neoadjuvant chemotherapy].
OBJECTIVE
To evaluate the influence of dexamethasone on the incidence of postoperative nausea and vomiting (PONV) in patients undergoing modified radical mastectomy with neoadjuvant chemotherapy.


METHODS
In a prospective trial, 280 female (18-60 years) breast cancer patients undergoing modified radical mastectomy with neoadjuvent chemotherapy were randomized to two groups: one with dexamethasone (Group D) and one without dexamethasone (Group C, n=140). In each group, anesthesia was maintained with volatile anesthesia or total intravenous anesthesia (TIVA): TIVA (propofol) without dexamethasone (Subgroup CP); volatile anesthesia (sevoflurane) without dexamethasone (Subgroup CS); TIVA with 10 mg dexamethasone intravenously before anesthetic induction (Subgroup DP); volatile anesthesia with 10 mg dexamethasone intravenously before anesthetic induction (Subgroup DS). A standard general anesthetic technique was used. All the patients received 8 mg of ondansetron intravenously 30 minutes before the end of surgical procedures. The incidence of PONV during the 24-hour postoperative period was recorded. A Logistic regression analysis was conducted to examine relevant factors for PONV. The tested factors were: age, body mass index (BMI), duration of surgery, postoperative pain, history of motion sickness/PONV, with or without dexamethasone and anesthetic regimen.


RESULTS
There was a significant lower incidence of PONV in the patients who received dexamethasone than in those who received placebo during the 24-hour postoperative period (11.4% vs. 20.7%, P=0.034). In the early postoperative period (0-2 h) dexamethasone reduced the incidence of PONV ( 1.4%vs.6.4%, P=0.031), but in the late postoperative period (2-24 h) the difference of the incidence was insignificantly (10.7% vs. 17.9%, P=0.088). No differences were found between TIVA and volatile anesthesia in the 24-hour postoperative period. Dexamethasone was effective to prevent PONV(OR=0.447, P=0.030), and history of PONV or motion sickness was the risk factor of PONV (OR=15.730, P<0.001).


CONCLUSIONS
Dexamethasone prevents PONV effectively in patients undergoing modified radical mastectomy with neoadjuvant chemotherapy, and TIVA cannot decrease the incidence of PONV in the 24-hour postoperative period in those patients.
Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Zhi-hong
ZH
Li
Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Dan
D
Liu
Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Zi-jing
ZJ
He
Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Zhi-yi
ZY
Fan
D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D000932:Antiemetics / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D008738:Methyl Ethers; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D017294:Ondansetron; D010149:Postoperative Pain; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D015742:Propofol; D011446:Prospective Studies; D000077149:Sevoflurane; D055815:Young Adult
D018686:Anesthetics, Intravenous; D000932:Antiemetics; D008738:Methyl Ethers; D000077149:Sevoflurane; D017294:Ondansetron; D003907:Dexamethasone; D015742:Propofol