title: Effect of perioperative dexamethasone on subjective voice quality after thyroidectomy: a meta-analysis and systematic review.
abstract: BACKGROUND
  Prophylactic dexamethasone has been shown to reduce postoperative pain, nausea, and vomiting in patients undergoing thyroidectomy. However, its effects on postoperative voice outcomes remain uncertain.
  
  
  METHODS
  A systematic review and meta-analysis of the literature was conducted. Cochrane database, MEDLINE, EMBASE, and CINAHL were thoroughly searched. Studies that compared intravenous dexamethasone administration with no dexamethasone in patients undergoing thyroidectomy were included. Main outcome measure was the difference in postoperative voice assessment between groups. Standardized mean difference (SMD) and 95 % confidence intervals (CIs) were estimated using fixed and random effects models.
  
  
  RESULTS
  Four studies with a total of 313 patients met inclusion criteria. Significant heterogeneity of study results was noted. Using random effects models, pooled data showed no difference in subjective voice quality between groups preoperatively (SMD, 0.29; 95 % CI -0.37 to 0.96; P = 0.39), 24 h after thyroidectomy (SMD, -1.02; 95 % CI -2.36 to 0.31; P = 0.13), or at 48 h (SMD, -0.05; 95 % CI -0.30 to 0.21; P = 0.72). A sensitivity analysis excluding one observational study yielded similar results.
  
  
  CONCLUSIONS
  There are insufficient data for definite conclusions to be drawn regarding the effectiveness of a single perioperative administration of dexamethasone to reduce short-term voice disturbances after thyroidectomy. Further prospective trials using objective voice analysis are warranted to evaluate the efficacy of dexamethasone.
authors.affiliation: Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, 92, Chung-Shan North Road, Section 2, Taipei, 10449, Taiwan.|Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan.
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Cheng
authors.affiliation: Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, 92, Chung-Shan North Road, Section 2, Taipei, 10449, Taiwan.|Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
authors.forename: Tsang-Pai
authors.initials: TP
authors.lastname: Liu
authors.affiliation: Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, 92, Chung-Shan North Road, Section 2, Taipei, 10449, Taiwan.|Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan.
authors.forename: Po-Sheng
authors.initials: PS
authors.lastname: Yang
authors.affiliation: Department of Otorhinolaryngology, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan.|Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
authors.forename: Kuo-Sheng
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, 92, Chung-Shan North Road, Section 2, Taipei, 10449, Taiwan. surg.mmh@gmail.com.|Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan. surg.mmh@gmail.com.
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Liu
mesh_terms: D003907:Dexamethasone / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D013965:Thyroidectomy; D014833:Voice Quality / Q000187:drug effects*
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone
keywords: Dexamethasone; Meta-analysis; Thyroidectomy; Voice