Postoperative sore throat and nausea and vomiting are common complaints in patients undergoing surgery, under general endotracheal anesthesia. Some of the studies have shown potential advantages of dexamethasone in prevention of postoperative sore throat. We therefore undertook a study to evaluate the efficacy of dexamethasone 8 mg administration intravenously, in reducing the incidence and severity of postoperative sore throat nausea and vomiting in patients undergoing caesarean section under general anesthesia with endotracheal intubation. METHODS: In a randomized, double blind and placebo controlled study, 60 patients receiving general anesthesia with endotracheal intubation undergoing caesarean section were randomly assigned to two groups. Group-I, patients received dexamethasone 8 mg IV and group-II received normal saline 2 ml IV. After surgery VAS score was used to assess sore throat and nausea, number of episodes of vomiting were recorded by a blinded observer. RESULTS: The overall incidence and severity of postoperative sore throat was less at all times in study group as compared to control group (p<0.001). 22 of 30 patients in dexamethasone group had sore throat as compared to 28 of 30 patients in control group (p<0.05). Even though there was no difference in the incidence of nausea in early postoperative period as compared to delayed postoperative period, there was significant reduction in severity of nausea in delayed and early postoperative period (p<0.001). There was no difference in incidence (p>0.05), but severity of vomiting was less in early postoperative period in dexamethasone group (p<0.001). There was significant reduction in incidence and severity of dexamethasone group in delayed postoperative period. CONCLUSION: Single dose dexamethasone reduces the incidence and severity of postoperative sore throat, nausea and vomiting in patients undergoing caesarean section under general endotracheal anesthesia.

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A 28-year-old man with schizophrenia intentionally ingested a lethal dose of acetaminophen and an unknown quantity of ibuprofen. He arrived at the hospital with acute renal and fulminant liver failure complicated by rhabdomyolysis. His creatine kinase level was 20,306 U/L on admission, which increased to 245,595 U/L by hospital day 2, and subsequently decreased to 339 U/L by day 16. The patient underwent liver transplantation on day 3; necrotic bowel was found during surgery. Rhabdomyolysis associated with acetaminophen overdose has been described only in a few case reports, but rarely in association with acetaminophen taken alone. The literature does not provide a clear association between acetaminophen and rhabdomyolysis because of other possible traumatic and nontraumatic causes. In this case, the Naranjo adverse drug reaction probability scale indicated a probable adverse reaction of rhabdomyolysis associated with acetaminophen overdose. In addition, nonsteroidal antiinflammatory agents (NSAIDs) are well known to be ulcerogenic in the upper gastrointestinal tract, but potential effects on the lower tract are less well known. Only a few NSAID-induced cases of ischemic colitis have been reported. Several mechanisms of action have been proposed, such as direct mucosal damage and inhibition of intestinal prostaglandin production. In this patient, the Naranjo scale indicated a probable adverse reaction of ischemic colitis associated with ibuprofen overdose. Patients who have taken an acetaminophen overdose should be assessed for rhabdomyolysis as a possible complication. In addition, an evaluation of ibuprofen-induced bowel necrosis in these patients may be warranted.

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