@2024 Afarand., IRAN
ISSN: 2252-0805 The Horizon of Medical Sciences 2016;22(2):89-94
ISSN: 2252-0805 The Horizon of Medical Sciences 2016;22(2):89-94
Comparison the Effects of Intravenous Hydrocortisone and Dexamethasone before Extubation on Laryngospasm, Cough and Stridor after General Anesthesia
ARTICLE INFO
Article Type
Original ResearchAuthors
Hamzei A. (1)Basiri Mogadam M. (2)
Yousef zadeh Ghoochani M. (3)
Heidary Karizaki M. (*)
(*) Nursing & Midwifery Department, Nursing & Midwifery Faculty, Gonabad University of Medical Sciences, Gonabad, Iran
(1) Anesthesia & Operating Room Department, Paramedical Faculty, Gonabad University of Medical Sciences, Gonabad, Iran
(2) “Social Development & Health Promotion Research Center” and “Nursing Department, Nursing & Midwifery Faculty”, Gonabad University of Medical Sciences, Gonabad, Iran
(3) Anesthesia & Operating Room Department, Paramedical Faculty, Mashhad University of Medical Sciences, Mashhad, Iran
Correspondence
Address: Aboureihan Boulevard, Hashemi Nejad Hospital, Mashhad, IranPhone: +985132706606
Fax: +985157220578
heidarykm1@mums.ac.ir
Article History
Received: August 2, 2015Accepted: January 11, 2016
ePublished: March 5, 2016
ABSTRACT
Aims
After tracheal extubation, following the patient’ waking up from general anesthesia, respiratory physiological responses are with symptoms such as cough, laryngospasm, and stridor. Different medications are used to prevent these complications. The aim of this study was to compare the effects of intravenous hydrocortisone and dexamethasone on the respiratory side-effects before tracheal extubation.
Materials & Methods In this two-blinded clinical trial, 108 patients candidate for orthopedic surgery, general surgery, and urology by general anesthesia hospitalized in Shahid Hashemi Nezhad and Bidaxt 15th Khordad hospitals were studied in Mashhad, Iran, in 2015. The subjects were selected via available sampling method. Randomized assignment was done by BBR. The first and the second groups received 100mg hydrocortisone and 8mg dexamethasone 30 minutes before tracheal extubation as one intravenous dosing, respectively. Individual information and clinical status were recorded based on the diagnoses by an anesthesiologist. Data was analyzed by SPSS 13 software using Chi-square, independent T, and Mann-Whitney tests.
Findings There was no significant difference between dexamethasone and hydrocortisone groups in the frequencies of cough, laryngospasm, and stridor (p>0.05). There were significant differences between the mean weights of patients with laryngospasm (p=0.03), cough (p=0.002), and stridor (p=0.001) and the patients without such symptoms. There was no significant difference in gender between patients with stridor and laryngospasm and other patients without such symptoms (p>0.05), excluding patients with cough (p=0.003).
Conclusion The effects of hydrocortisone and dexamethasone are similar on laryngospasm, cough, and stridor after tracheal extubation.
Materials & Methods In this two-blinded clinical trial, 108 patients candidate for orthopedic surgery, general surgery, and urology by general anesthesia hospitalized in Shahid Hashemi Nezhad and Bidaxt 15th Khordad hospitals were studied in Mashhad, Iran, in 2015. The subjects were selected via available sampling method. Randomized assignment was done by BBR. The first and the second groups received 100mg hydrocortisone and 8mg dexamethasone 30 minutes before tracheal extubation as one intravenous dosing, respectively. Individual information and clinical status were recorded based on the diagnoses by an anesthesiologist. Data was analyzed by SPSS 13 software using Chi-square, independent T, and Mann-Whitney tests.
Findings There was no significant difference between dexamethasone and hydrocortisone groups in the frequencies of cough, laryngospasm, and stridor (p>0.05). There were significant differences between the mean weights of patients with laryngospasm (p=0.03), cough (p=0.002), and stridor (p=0.001) and the patients without such symptoms. There was no significant difference in gender between patients with stridor and laryngospasm and other patients without such symptoms (p>0.05), excluding patients with cough (p=0.003).
Conclusion The effects of hydrocortisone and dexamethasone are similar on laryngospasm, cough, and stridor after tracheal extubation.
CITATION LINKS
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[3]Moein Vaziri TM, Jouybar R, Moein Vaziri N, Moein Vaziri N, Panah A. Attenuation of cardiovascular responses and upper airway events to tracheal extubation by low dose propofol. Iran Red Crescent Med J. 2013;15(4):298-301.
[4]Khan MA, Siddiqi KJ, Aqeel M. Lidocaine 4% spray is better than intracuff lidocaine 2% for reducing the incidence of post-extubation cough in patients undergoing total abdominal hysterectomy. Anaesth Pain Intensive Care. 2014;18(2):162-6.
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[6]Gousheh SMR, Tayaranian noorani H, pipelzadeh MR, Behaeen K, Olapure AR. The effect of low-dose remifentanil on responses to the endotracheal tube during emergence from general anesthesia. Anesthesiol Pain. 2013;4(1):46-72. [Persian]
[7]Maury E, Guglielminotti J, Alzieu M, Qureshi T, Guidet B, Offenstadt G. How to identify patients with no risk for postextubation stridor?. J Crit Care. 2004;19(1):23-8.
[8]Jaber S, Jung B, Chanques G, Bonnet F, Marret E. Effects of steroids on reintubation and post-extubation stridor in adults: meta-analysis of randomised controlled trials. Crit Care. 2009;13(2):R49.
[9]Jubb A, Ford P. Extubation after anaesthesia: A systematic review. Update Anaesth. 2009;25(1):30-6.
[10]Kumar S, Gupta A, Srivastava U, Chandra V, Gain M, Sarkar D, et al. Role of dexamethasone in reducing post extubation sore throte، horseness of voice and cough after general. Caribb J Sci Technol. sei tech. 2014;2:330-5.
[11]Hosseini Valami SM, Hosseini Jahromi SA, Gholami H. Effect of topical betamethasone on reduction of sore throat and cough due to endotracheal intubation during general anesthesia. J Qazvin Univ Med Sci. 2004;7(29):21-4. [Persian]
[12]Marzban S, Haddadi S, Naghipour M, Sayah Varg Z, Naderi Nabi B. The effect of intravenous magnesium sulfate on laryngospasm after elective adenotonsillectomy surgery in children. Anesthesiol Pain Med. 2014;4(1):e15960.
[13]Ahmadinejad M, Khodadadi MT, Nohi E, Avazeh A. The effect of intravenous dexamethasone versus inhaled budesonide on the reduction of post extubation stridor in ICU patients. J Zanjan Univ Med Sci. 2012;20(81):85-92. [Persian]
[14]Honarmand A, Khazaei M, Safavi Homami MR. Comparative effect of low dose propofol, ketamine, and combining the two in the prevention of cough spasm after extubation laryngoscopic. J Med Sch Isfahan. 2014;32(297):1299-309. [Persian]
[15]Cevc G, Blume G. Hydrocortisone and dexamethasone in very deformable drug carriers have increased biological potency, prolonged effect, and reduced therapeutic dosage. Biochim Biophys Acta. 2004;1663(1-2):61-73.
[16]Roberts RJ, Welch SM, Devlin JW. Corticosteroids for prevention of postextubation laryngeal edema in adults. Ann Pharmacother. 2008;42(5):686-91.
[17]Epstein SK. Corticosteroids to prevent postextubation upper airway obstruction: The evidence mounts. Crit Care. 2007;11(4):156.
[18]Wang CL, Tsai YH, Huang CC, Wu YK, Ye MZ, Chou HM, et al. The role of the cuff leak test in predicting the effects of corticosteroid treatment on postextubation stridor. Chang Gung Med J. 2007;30(1):53-61.
[19]McCaffrey J, Farrell C, Whiting P, Dan A, Bagshaw SM, Delaney AP. Corticosteroids to prevent extubation failure: A systematic review and meta-analysis. Intensive Care Med. 2009;35(6):977-86.
[20]Hoshino M, Ohtawa J. Effects of budesonide/formoterol combination therapy versus budesonide alone on airway dimensions in asthma. Respirol. 2012;17(4):639-46.
[21]Fan T, Wang G, Mao B, Xiong Z, Zhang Yu, Liu X, et al. Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: Meta-analysis of randomised placebo controlled trials. BMJ. 2008;337:a1841.
[22]Park SH, Han SH, Do SH, Kim JW, Rhee Ky, Kim JH. Prophylactic dexamethasone decreases the incidence of sore throat and hoarseness after tracheal extubation with a double-lumen endobronchial tube. Anesth Analg. 2008;107(6):1814-8.
[23]Ayoub CM, Ghobashy A, Koch ME, McGrimley L, Pascale V, Qadir S. Widespread application of topical steroids to decrease sore throat, hoarseness, and cough after tracheal intubation. Anesth Analg. 1998;87(3):714-6.
[24]Malhotra D, Gurcoo S, Qazi S, Gupta S. Randomized comparative efficacy of dexamethasone to prevent postextubation upper airway complications in children and adults in ICU. Indian J Anaesth. 2009;53(4):442-9.
[25]Lee CH, Peng MJ, Wu CL. Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study. Crit Care. 2007;11(4):R72.
[26]Ho LI, Harn HJ, Lien TC, Hu PY, Wang JH. Postextubation laryngeal edema in adults risk factor evaluation and prevention by hydrocortisone. Intensive Care Med. 1996;22(9):933-6.
[27]Kep Kee W, Nadia MN, Melvin K, Muhammad M, Raha AR, Nurlia Y. Post-intubation airway related adverse effects: a comparison between intra-cuff dexamethasone and intra-cuff alkalinized lignocaine. J Surg Acad. 2013;3(2):26-31.
[28]Mohmdzadh AS, Gafarpoor M, Zarifnejad GH. Determine the effects of hydrocortisone on hoarseness after tracheal intubation in patients undergoing oral surgery of the gastrointestinal tract. Asrar. 2000;8(1):38-44. [Persian]
[29]Rafiei MR, Arianpour N, Rezvani M, Ebrahimi A. Effects of intracuff dexamethasone on post-extubation reactions. J Res Med Sci. 2012;17(4):338-43.
[30]lak M, Frousanmehr M, farhady A. The effect of dexamethasone on prevention of laryngospasm after extubation in children. Trauma Mon. 2008;13(3):223-8.
[2]Hu C, Yu H, Ye M, Shen X. Sevoflurane in combination with remifentanil for tracheal extubation after otologic surgery. Am J Health Syst Pharm. 2014;71(13):1108-11.
[3]Moein Vaziri TM, Jouybar R, Moein Vaziri N, Moein Vaziri N, Panah A. Attenuation of cardiovascular responses and upper airway events to tracheal extubation by low dose propofol. Iran Red Crescent Med J. 2013;15(4):298-301.
[4]Khan MA, Siddiqi KJ, Aqeel M. Lidocaine 4% spray is better than intracuff lidocaine 2% for reducing the incidence of post-extubation cough in patients undergoing total abdominal hysterectomy. Anaesth Pain Intensive Care. 2014;18(2):162-6.
[5]Norozy V, Mohamadiayn Ardy A. Effect of intravenous dexamethasone in dimishing alfentanyl-induced-cough. J Soc Anesthesiol Spec Care. 2010;31(70):55-61. [Persian]
[6]Gousheh SMR, Tayaranian noorani H, pipelzadeh MR, Behaeen K, Olapure AR. The effect of low-dose remifentanil on responses to the endotracheal tube during emergence from general anesthesia. Anesthesiol Pain. 2013;4(1):46-72. [Persian]
[7]Maury E, Guglielminotti J, Alzieu M, Qureshi T, Guidet B, Offenstadt G. How to identify patients with no risk for postextubation stridor?. J Crit Care. 2004;19(1):23-8.
[8]Jaber S, Jung B, Chanques G, Bonnet F, Marret E. Effects of steroids on reintubation and post-extubation stridor in adults: meta-analysis of randomised controlled trials. Crit Care. 2009;13(2):R49.
[9]Jubb A, Ford P. Extubation after anaesthesia: A systematic review. Update Anaesth. 2009;25(1):30-6.
[10]Kumar S, Gupta A, Srivastava U, Chandra V, Gain M, Sarkar D, et al. Role of dexamethasone in reducing post extubation sore throte، horseness of voice and cough after general. Caribb J Sci Technol. sei tech. 2014;2:330-5.
[11]Hosseini Valami SM, Hosseini Jahromi SA, Gholami H. Effect of topical betamethasone on reduction of sore throat and cough due to endotracheal intubation during general anesthesia. J Qazvin Univ Med Sci. 2004;7(29):21-4. [Persian]
[12]Marzban S, Haddadi S, Naghipour M, Sayah Varg Z, Naderi Nabi B. The effect of intravenous magnesium sulfate on laryngospasm after elective adenotonsillectomy surgery in children. Anesthesiol Pain Med. 2014;4(1):e15960.
[13]Ahmadinejad M, Khodadadi MT, Nohi E, Avazeh A. The effect of intravenous dexamethasone versus inhaled budesonide on the reduction of post extubation stridor in ICU patients. J Zanjan Univ Med Sci. 2012;20(81):85-92. [Persian]
[14]Honarmand A, Khazaei M, Safavi Homami MR. Comparative effect of low dose propofol, ketamine, and combining the two in the prevention of cough spasm after extubation laryngoscopic. J Med Sch Isfahan. 2014;32(297):1299-309. [Persian]
[15]Cevc G, Blume G. Hydrocortisone and dexamethasone in very deformable drug carriers have increased biological potency, prolonged effect, and reduced therapeutic dosage. Biochim Biophys Acta. 2004;1663(1-2):61-73.
[16]Roberts RJ, Welch SM, Devlin JW. Corticosteroids for prevention of postextubation laryngeal edema in adults. Ann Pharmacother. 2008;42(5):686-91.
[17]Epstein SK. Corticosteroids to prevent postextubation upper airway obstruction: The evidence mounts. Crit Care. 2007;11(4):156.
[18]Wang CL, Tsai YH, Huang CC, Wu YK, Ye MZ, Chou HM, et al. The role of the cuff leak test in predicting the effects of corticosteroid treatment on postextubation stridor. Chang Gung Med J. 2007;30(1):53-61.
[19]McCaffrey J, Farrell C, Whiting P, Dan A, Bagshaw SM, Delaney AP. Corticosteroids to prevent extubation failure: A systematic review and meta-analysis. Intensive Care Med. 2009;35(6):977-86.
[20]Hoshino M, Ohtawa J. Effects of budesonide/formoterol combination therapy versus budesonide alone on airway dimensions in asthma. Respirol. 2012;17(4):639-46.
[21]Fan T, Wang G, Mao B, Xiong Z, Zhang Yu, Liu X, et al. Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: Meta-analysis of randomised placebo controlled trials. BMJ. 2008;337:a1841.
[22]Park SH, Han SH, Do SH, Kim JW, Rhee Ky, Kim JH. Prophylactic dexamethasone decreases the incidence of sore throat and hoarseness after tracheal extubation with a double-lumen endobronchial tube. Anesth Analg. 2008;107(6):1814-8.
[23]Ayoub CM, Ghobashy A, Koch ME, McGrimley L, Pascale V, Qadir S. Widespread application of topical steroids to decrease sore throat, hoarseness, and cough after tracheal intubation. Anesth Analg. 1998;87(3):714-6.
[24]Malhotra D, Gurcoo S, Qazi S, Gupta S. Randomized comparative efficacy of dexamethasone to prevent postextubation upper airway complications in children and adults in ICU. Indian J Anaesth. 2009;53(4):442-9.
[25]Lee CH, Peng MJ, Wu CL. Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study. Crit Care. 2007;11(4):R72.
[26]Ho LI, Harn HJ, Lien TC, Hu PY, Wang JH. Postextubation laryngeal edema in adults risk factor evaluation and prevention by hydrocortisone. Intensive Care Med. 1996;22(9):933-6.
[27]Kep Kee W, Nadia MN, Melvin K, Muhammad M, Raha AR, Nurlia Y. Post-intubation airway related adverse effects: a comparison between intra-cuff dexamethasone and intra-cuff alkalinized lignocaine. J Surg Acad. 2013;3(2):26-31.
[28]Mohmdzadh AS, Gafarpoor M, Zarifnejad GH. Determine the effects of hydrocortisone on hoarseness after tracheal intubation in patients undergoing oral surgery of the gastrointestinal tract. Asrar. 2000;8(1):38-44. [Persian]
[29]Rafiei MR, Arianpour N, Rezvani M, Ebrahimi A. Effects of intracuff dexamethasone on post-extubation reactions. J Res Med Sci. 2012;17(4):338-43.
[30]lak M, Frousanmehr M, farhady A. The effect of dexamethasone on prevention of laryngospasm after extubation in children. Trauma Mon. 2008;13(3):223-8.