Dexamethasone in head and neck cancer patients with microvascular reconstruction: No benefit, more complications

Kainulainen, Satu; Törnwall, Jyrki; Koivusalo, Anna-Maria; Suominen, Anna-Liisa; Lassus, Patrik

doi:10.1016/j.oraloncology.2016.12.008

Cited by 14 publications

(14 citation statements)

References 33 publications

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“…In their previous study of the same study population, the authors found that the use of dexamethasone was associated with more complications, especially regarding postoperative infections. 18 Postoperative pain management relieves suffering, can accelerate earlier mobilization, and decrease hospital stay duration and costs. Many published reports in different surgical fields have described the analgesic effect of steroids.…”

Section: Discussionmentioning

confidence: 99%

“…A detailed description of preoperative medical data, surgical data, TNM classifications, parameters during surgery, and complications rated can be found in the authors' previous study. 18 Surgery was performed under standard balanced anesthesia. Patients were given antibiotics targeted for days, starting with cefuroxime 1.5 g Â 3 IV and metronidazole 500 mg 1 Â 3 IV on induction of general anesthesia.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, all infections that required surgical intervention within 3 weeks of the operation occurred in patients receiving dexamethasone. 18 PONV is a common complication after anesthesia and surgery. Emetic episodes can cause numerous complications, such as gastric aspiration, wound dehiscence, psychological distress, and delayed recovery and discharge times.…”

Section: Q3mentioning

confidence: 99%

See 2 more Smart Citations

More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial

Kainulainen

Lassus

Suominen

et al. 2018

Journal of Oral and Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Q3mentioning

confidence: 99%

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More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial

Kainulainen

Lassus

Suominen

et al. 2018

Journal of Oral and Maxillofacial Surgery

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“…Their data thus did not support the use of peri-and post-operative dexamethasone in oropharyngeal cancer patients undergoing microvascular reconstruction. 38 Dexamethasone 8-10 mg is associated with a significantly greater peri-operative increase in blood glucose compared with a 4 mg dose. This model estimated the increase in post-operative glucose to be 25 mg/dL higher over 24 hours with dexamethasone 8-10 mg than with 4 mg (95% confidence limits, 18-32 mg/dL).…”

Section: Adverse Effects Of Dexamethasonementioning

confidence: 96%

Role of Dexamethasone in Peri-operative Anesthesia Management: A Review of Literature

Gupta¹

2017

Anesthesiol Open J

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Dexamethasone has been used widely in clinical specialties including anesthesia. It is regarded as one of the ideal peri-operative agent being readily available, cheap, anti-inflammatory agent, prevents and treats post-operative nausea and vomiting (PONV), promotes appetite, suppress inflammation, a good analgesic agent both as intravenously or as an adjuvant to peripheral nerve blocks, it provides a sense of well-being and is considered to have a good quality of recovery and early discharge in patients from anesthesia. Controversial role of dexamethasone in causing post-operative surgical site infections have been solved and overall adverse effects of dexamethasone are rare and its benefits out-weighs the risks involved. The author did a literature search in Google Scholar and PubMed databases (latest articles related to the role of dexamethasone in peri-operative period over a period of two years 2015-17).KEY WORDS: Dexamethasone; Peri-operative agent; Anesthesia. KEY MESSAGES:Dexamethasone has a tremendous role in preventing post-operative nausea and vomiting, it has a fair analgesic action if given intravenously, epidurally or perineurally, patients receiving dexamethasone have enhanced recovery profiles after surgery and single dose would usually not increase the risk of surgical site infections. Overall adverse effects of dexamethasone are rare and its benefits out-weighs the risks involved.

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“…10 We have previously shown that the use of perioperative DEX increases the incidence of major complications in patients with HNC undergoing microvascular reconstruction, which could also have affected patient survival. 11 Thus, the purpose of the present study was to investigate whether the use of perioperative DEX would influence the short-term survival of patients with HNC. The second aim was to assess the causes of death and the factors associated with mortality during long-term follow-up of patients who had undergone surgery and reconstruction for HNC.…”

mentioning

confidence: 99%

Perioperative Dexamethasone Is Associated With Higher Short-Term Mortality in Reconstructive Head and Neck Cancer Surgery

Kainulainen

Aro

Koivusalo

et al. 2020

Journal of Oral and Maxillofacial Surgery

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Purpose: Studies of the effects of perioperative dexamethasone (DEX) during oncologic surgery are scarce. The first aim of the present study was to clarify whether perioperative DEX affects the shortterm mortality in patients with head and neck cancer (HNC). The second aim was to analyze the causes of death and predictors affecting long-term mortality. Patients and Methods: The present prospective, double-blind randomized, controlled study included patients with HNC who had undergone microvascular reconstruction from 2008 through 2013. The patients were randomized into 2 groups: the receipt of perioperative DEX for 3 days (study group) or no DEX (control group). The patients' data and cause of death were registered until the end of 2017. The primary cause of death was used in the analyses. Results: A total of 93 patients were included in the present study: 51 in the DEX group (study group) and 42 in the NON-DEX group (control group). Altogether 38 patients died during a median follow-up period of 5.3 years. During the first year, more deaths had occurred in the DEX group than in the NON-DEX group: at 1 month, 4% versus 0%; at 6 months, 14% versus 0%; and at 12 months, 22% versus 5% (P = .043). The overall survival rate for all patients was 59%. HNC was the primary cause of death for most of the patients who died. On univariate analysis, the deceased patients had more advanced disease (higher T classification, P = .002; higher stage, P = .008), a greater need for a gastrostoma (P = .002), more often received postoperative chemotherapy (P = .005), and more often had locoregional (P = .025) or distal (P < .001) metastases. In the multivariate Cox model, the most important long-term predictors of death were the presence of

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Dexamethasone in head and neck cancer patients with microvascular reconstruction: No benefit, more complications

Cited by 14 publications

References 33 publications

More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial

More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial

Role of Dexamethasone in Peri-operative Anesthesia Management: A Review of Literature

Perioperative Dexamethasone Is Associated With Higher Short-Term Mortality in Reconstructive Head and Neck Cancer Surgery

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