Effects of single dose, postinduction dexamethasone on recovery after cardiac surgery

Background. Corticosteroids have been recommended to facilitate rapid recov ery after cardiac surgery. We previously reported that dexamethasone given after induction of anesthesia decreases the incidence of postoperative shiv ering. We performed a post hoc analysis of the data obtained during that st udy, focusing on secondary outcomes. Methods. A total of 235 adult patients undergoing elective coronary or valv ular heart surgery were randomized to receive dexamethasone 0.6 mg/kg or pl acebo after induction of anesthesia. Patients who had pharmacologically tre ated diabetes mellitus, had hypersensitivity to dexamethasone, or were rece iving treatment with corticosteroids were excluded. Results. We found that, compared with placebo, patients receiving dexametha sone were more likely to remain tracheally intubated for 6 hours or less (2 6.4% vs 10.0%, p = 0.020) and had a lower incidence of early postoperative fever (20.2% vs 36.8%, p = 0.009) and new-onset atrial fibrillation during the first 3 days postoperatively (18.9% vs 32.3%, p = 0.027). However, we c ould not demonstrate a statistical difference in the intensive care unit or hospital length of stay, or in overall morbidity and mortality. The dexame thasone-treated patients were also more likely to have a higher blood gluco se on admission to the intensive care unit (186 mg/dL vs 143 mg/dL, p = 0.0 12). Conclusions. Dexamethasone facilitates early tracheal extubation and is ass ociated with a lower incidence of early postoperative fever and new-onset a trial fibrillation. Apart from a treatable decreased glucose tolerance, dex amethasone treatment was not shown to affect morbidity or mortality signifi cantly. (C) 2000 by The Society of Thoracic Surgeons.