Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials

Fan, Tao; Wang, Gang; Mao, Bing; Xiong, Zeyu; Zhang, Yu; Liu, Xuemei; Wang, Lei; Yang, Shaojie

doi:10.1136/bmj.a1841

Cited by 73 publications

(55 citation statements)

References 24 publications

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“…1,7,12,15,18 The evaluation of perioperative steroid use in spinal surgery, however, has been relatively limited; only 1 study has provided Level 1 evidence. 10,26,30 That study did not find a benefit for parenteral steroid use in expediting extubation after multilevel cervical corpectomy surgery.…”

Section: Discussionmentioning

confidence: 99%

Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial

Jeyamohan¹,

Kenning²,

Petronis³

et al. 2015

SPI

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OBJECT Anterior cervical discectomy and fusion (ACDF) is an effective procedure for the treatment of cervical radiculopathy and/or myelopathy; however, postoperative dysphagia is a significant concern. Dexamethasone, although potentially protective against perioperative dysphagia and airway compromise, could inhibit fusion, a generally proinflammatory process. The authors conducted a prospective, randomized, double-blinded, controlled study of the effects of steroids on swallowing, the airway, and arthrodesis related to multilevel anterior cervical reconstruction in patients who were undergoing ACDF at Albany Medical Center between 2008 and 2012. The objective of this study was to determine if perioperative steroid use improves perioperative dysphagia and airway edema. METHODS A total of 112 patients were enrolled and randomly assigned to receive saline or dexamethasone. Data gathered included demographics, functional status (including modified Japanese Orthopaedic Association myelopathy score, neck disability index, 12-Item Short-Form Health Survey score, and patient-reported visual analog scale score of axial and radiating pain), functional outcome swallowing scale score, interval postoperative imaging, fusion status, and complications/reoperations. Follow-up was performed at 1, 3, 6, 12, and 24 months, and CT was performed 6, 12, and 24 months after surgery for fusion assessment. RESULTS Baseline demographics were not significantly different between the 2 groups, indicating adequate randomization. In terms of patient-reported functional and pain-related outcomes, there were no differences in the steroid and placebo groups. However, the severity of dysphagia in the postoperative period up to 1 month proved to be significantly lower in the steroid group than in the placebo group (p = 0.027). Furthermore, airway difficulty and a need for intubation trended toward significance in the placebo group (p = 0.057). Last, fusion rates at 6 months proved to be significantly lower in the steroid group but lost significance at 12 months (p = 0.048 and 0.57, respectively). CONCLUSIONS Dexamethasone administered perioperatively significantly improved swallowing function and airway edema and shortened length of stay. It did not affect pain, functional outcomes, or long-term swallowing status. However, it significantly delayed fusion, but the long-term fusion rates remained unaffected. Clinical trial registration no.: NCT01065961 (clinicaltrials.gov)

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Section: Discussionmentioning

confidence: 99%

Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial

Jeyamohan¹,

Kenning²,

Petronis³

et al. 2015

SPI

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“…Doxapram has been used to prevent and ⁄ or treat laryngospasm, although it is associated with cardiovascular stimulation and robust evidence to support its use for this indication is lacking [104]. The use of steroids to reduce inflammatory airway oedema is described below [105][106][107].…”

Section: General Principlesmentioning

confidence: 99%

“…Steroids reduce inflammatory airway oedema resulting from direct airway injury (surgical ⁄ anaesthetic ⁄ thermal ⁄ chemical) [105][106][107]155], but have no effect on mechanical oedema secondary to venous obstruction (e.g. neck haematoma).…”

Section: Equipment and Monitorsmentioning

confidence: 99%

Difficult Airway Society Guidelines for the management of tracheal extubation

Mitchell¹,

Dravid²,

Patel³

et al. 2012

Anaesthesia

430

139

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SummaryTracheal extubation is a high‐risk phase of anaesthesia. The majority of problems that occur during extubation and emergence are of a minor nature, but a small and significant number may result in injury or death. The need for a strategy incorporating extubation is mentioned in several international airway management guidelines, but the subject is not discussed in detail, and the emphasis has been on extubation of the patient with a difficult airway. The Difficult Airway Society has developed guidelines for the safe management of tracheal extubation in adult peri‐operative practice. The guidelines discuss the problems arising during extubation and recovery and promote a strategic, stepwise approach to extubation. They emphasise the importance of planning and preparation, and include practical techniques for use in clinical practice and recommendations for post‐extubation care.

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“…Summary RR for the association between PD and different outcomes (AE, hospitalization because of asthma, ED visit because of asthma, unscheduled doctor visit because of asthma, and SCS use) were calculated using Stata Version 11.0 (Stata Corp. LP, College Station, TX). Heterogeneity in every effect estimate was assessed using the I 2 statistic and the Cochran Q method, as in our previous studies (17,18). A random-effects metaanalysis model was used to calculate pooled estimates when substantial heterogeneity was observed (I 2 >50.0%…”

Section: Statistical Analysis and Quality Of The Evidence Assessmentmentioning

confidence: 99%

Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

Zhang

Zheng³

et al. 2016

J. Thorac. Dis.

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Background:The longitudinal associations between psychological dysfunction (PD) and asthma exacerbations (AE) have not been adequately addressed. This study aimed to systematically assess the influence of PD on AE, and to determine whether different PD affects AE differentially. P<0.001], presenting as hospitalizations (RR adj =1.22, 95% CI: 1.12-1.34, P<0.001), unscheduled doctor visits (RR =4.26, 95% CI: 2.52-7.19), and emergency department (ED) visits (RR adj =1.06, 95% CI: 1.01-1.10, P=0.009) because of asthma. Depression significantly increased the risk of AE (RR adj =1.07, 95% CI: 1.04-1.11, P<0.001), presenting as hospitalizations (RR adj =1.26, 95% CI: 1.07-1.49, P=0.007) and ED visits (RR adj =1.06, 95% CI: 1.02-1.11, P=0.007) because of asthma. Anxiety was only associated with an increased risk of AE in pregnant women (RR =1.05, 95% CI: 1.01-1.08), possibly due to the small amount of data available on anxiety. The influence of PD on AE was only significant when the PD exposure time exceeded one year.Conclusions: Co-morbid PD adversely affects AE, and there are differential effects of depression and anxiety. Asthmatic subjects with PD may benefit from more attention when establishing a treatment regimen in clinical practice.

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Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials

Cited by 73 publications

References 24 publications

Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial

Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial

Difficult Airway Society Guidelines for the management of tracheal extubation

Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

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