@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2016;22(2):89-94

Background
… [1-15] Intravenous corticosteroids including dexamethasone due to anti-inflammatory properties have an important role in reducing airway edema and stridor caused by it [8, 16].
Previous Studies
Use of steroids may be effective in the prevention of upper airway obstruction after extubation [17]. The use of corticosteroids reduces the cases of stridor after exubation [18]. Betamethasone, also, decreases cough and hoarseness caused by intubation [11].
Aim(s)
The aim of this study was to compare the effects of intravenous dexamethasone and hydrocortisone before extubation on the respiratory side effects.
Research type
This study is a double blind clinical trial.
Research society, place and time
Patients undergoing orthopedic surgery, general surgery and urology under general anesthesia were studied in Bidakht and Hasheminejad hospitals in Mashhad in 2015.
Sampling method and number
108 patients were studied. The sample size was estimated 49, considered as 54 people per group. Samples were selected via convenience method.
Used devices&materials
Random sampling was done via BBR method. Samples were divided into 27 blocks (four samples per block) and six different modes were considered. From number one to six, a number was chosen by lottery and other numbers were selected in raw from the table of random numbers. Then they were assigned into two groups of hydrocortisone and dexamethasone. The method of induction and anesthetic management was fixed in both groups, and midazolam (1-2 mg) and fentanyl (1-2 µg/kg) were used as premedication. Then, induction of anesthesia was carried out using thiopental sodium (5 mg/kg) and atracurium (0.5 mg/kg). Group 1 received 100 mg hydrocortisone and group 2 received 8 mg dexamethasone both 30 minutes before excubation as an intravenous dose. Data were analyzed using SPSS 13. To compare stridor qualitative variables, the severity of laryngospasm, and the severity of cough in two groups, Chi-squared test was used. And to compare demographic quantitative variables in two groups, independent T-test was used. In case of non-normality of data distribution, Mann-Whitney test and in case of comparing demographic qualitative variables Chi-square test were used.
Findings by Text
The mean age in dexamethasone group was 27.87 ± 9.56 years and it was 29.68 ± 11.20 years in hydrocortisone group. The average weight in the dexamethasone group was 67.25 ± 84.11 kg and it was 70.38 ± 11.80 kg in the hydrocortisone group. There was no statistically significant difference between two groups in terms of mean age (p = 0.36), weight (p=0.17), sex distribution (p = 0.67), education (p=0.82), and occupation (p = 0.81; Table 1). The difference between the mean duration of endotracheal tube in dexamethasone group (54 patients) and hydrocortisone group (54 patients) was not significantly different (p = 0.49), and the two groups were similar. The frequency of incidence of cough, laryngospasm and stridor were not significantly different between the two groups of dexamethasone and hydrocortisone (Table 2). Laryngospasm and cough severity were not significantly different in two groups including dexamethasone (p= 0.68) and hydrocortisone (p=0.56). No statistically significant correlation was observed between the age of subjects on one hand and the cough severity (p= 0.56), laryngospasm (p= 0.8), and stridor (p= 0.26) on the other hand. However, the mean weight of patients with laryngospasm (p= 0.03), cough (p= 0.002), and stridor (p= 0.001) significantly differed with the patients who did not have these symptoms. In gender, there was no statistically significant difference between patients who had stridor (p= 0.19), and laryngospasm (p = 0.06) and those without such symptoms except in those patients with cough showing a significant difference (p = 0.003). The frequency distribution of the subjects in the two groups in terms of the type of surgery (p= 0.91) and ASA Class (p= 0.62) was not significantly different and the two groups were similar in this regard.
Main comparison to the similar studies
The effect of intravenous dexamethasone and hydrocortisone on coughing, laryngospasm, and stridor was similar between the groups and no statistically significant difference was observed between them. 1 mg dexamethasone is equivalent to 5 mg prednisolone, 5 mg methylprednisolone, and 25 mg hydrocortisone. In addition, the effect of dexamethasone is 20 times more than the effect of hydrocortisone and it is more lasting [19]. Corticosteroids reduce the tissue response to inflammatory processes through inhibition of factors such as mast cells, eosinophils, macrophages, lymphocytes, and increasing neutrophils [20]. Steroids are commonly used in airway disabilities [10]. The utilization of steroids before extubation prevents the complications of airway in the patients [21]. Laryngeal edema, which is a common complication of stridor, is reduced at any age by the utilization of corticosteroid, which is also effective on the inflammatory responses caused by induced tracheal tube [16, 19]. 1 to 24 hours utilization of dexamethasone as prophylaxis after extubation reduces the prevalence of sound violence and laryngospasm [22]. Betamethasone and dexamethasone gel has been used to reduce cough and hoarseness after the surgery and it shows a statistically significant difference compared to control group [10, 23]. However, there was no statistically significant difference between two groups in cough and stridor and the reduction of cough and stridor was less than the above mentioned studies. The incidence of cough in this study was reported 18.5 % in dexamethasone group and 24.1 % in hydrocortisone group, showing that the incidence of cough significantly decreased by the consumption of two medications compared with other studies. In another study, the reduction of respiratory complications, caused by extubation, by the consumption of dexamethasone has been approved [24]. The effects of dexamethasone and hydrocortisone on stridor reduction have been confirmed [25, 26]. The use of dexamethasone and hydrocortisone is useful in reducing the symptoms of hoarseness which is caused by stridor [27, 28]. In this study, different doses of dexamethasone including 0.1 and 0.2 mg per kg of body weight were used in the groups. And 0.2 mg dose had a better effect on reduction of hoarseness. However, in the latter study, one dose of dexamethasone has been used. In addition, in another study the use of hydrocortisone has had less impact on the hoarseness in females. This is while, in our study the effect of gender was not statistically significant and the groups were similar. Dexamethasone has been effective on severe cough, but in hoarseness which is a symptom of stridor [29]. The result is consistent with the present results. … [30]
Suggestions
The drugs should be compared in a variety of surgical processes with more samples and a wider age range.
Limitations
There was no limitation.
Conclusions
Hydrocortisone and dexamethasone have similar effects on laryngospasm, coughing, and stridor after extubation.
Acknowledgments
The staffs of 15 Khordad hospital of Bidakht (Gonabad) and Hasheminejad hospital (Mashhad) are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
The study was approved by the ethics committee of Gonabad University of Medical Sciences.
Funding Sources
This study was approved by Council of Graduate Studies and Research Council of Gonabad University of Medical Sciences.

TABLES and CHARTS

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