The Effect of Dexamethasone on Cortisol Levels in Patients Undergoing Thyroid Surgery

April 18, 2016 updated by: Jill Osborn, St. Paul's Hospital, Canada

The Effect of Dexamethasone on Plasma Cortisol Levels, Pain and PONV in Female Patients Undergoing Thyroid Surgery

Many drugs are used to prevent nausea and vomiting and pain after surgery. In this study the investigators will be looking at a drug, dexamethasone, which is commonly used to prevent nausea and vomiting and pain after surgery but has other side effects. Dexamethasone is a man-made drug that is commonly used during surgery but also can affect naturally occuring hormones. In this study the investigators will be looking at dexamethasone's effect on a number of naturally occuring hormones over a twenty four hour period after thyroid surgery. The investigators hypothesize that plasma cortisol levels will be decreased following administration of dexamethasone.

Study Overview

Status

Withdrawn

Conditions

Intervention / Treatment

Detailed Description

Purpose To examine the effect of dexamethasone, on plasma cortisol levels, postoperative pain, nausea and vomiting in patients undergoing thyroid surgery.

Hypothesis That dexamethasone administered at induction of anesthesia will result in reduced plasma cortisol levels, postoperative pain, nausea and vomiting.

Justification Dexamethasone is a synthetic steroid medication used routinely to prevent nausea and vomiting in patients undergoing general anesthetic. Administration of exogenous steroids can suppress production of endogenous steroids including cortisol.

Currently, no data exists describing the degree of suppression of cortisol production by a single preoperative dose of dexamethasone. This information would guide physicians prescribing dexamethasone in the perioperative period.

Objectives To compare plasma cortisol levels in patients receiving dexamethasone versus placebo at induction of anesthesia. To investigate the effect of dexamethasone on postoperative pain, nausea and vomiting.

Research Methods A prospective, randomized, controlled, double-blinded study conducted at a single center. Thirty patients will be recruited and randomly assigned to dexamethasone or placebo groups, in accordance with sample size calculations. A placebo group is necessary to eliminate the effects of potential confounding factors.

Statistical Analysis An interim analysis will be conducted to confirm the sample size calculation. Plasma cortisol level will be analyzed using 2-way analysis of variance (ANOVA). Secondary outcome measures will be analyzed with appropriate parametric or nonparametric methods.

Study Type

Interventional

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • British Columbia
      • Vancouver, British Columbia, Canada, V6Z 1Y6
        • St Paul's Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Female adult patients
  • Undergoing thyroid surgery
  • Euthyroid patients
  • Qualify as Class I or II according to the American Society of Anesthesiologists physical status classification system
  • Written informed consent

Exclusion Criteria:

  • Patients who have medical conditions associated with abnormalities of the hypothalamic-pituitary-adrenal axis which might alter plasma cortisol levels will be excluded from the study. This category includes the following conditions:

    1. A diagnosis of anxiety, depression or bipolar disorder
    2. Disorders of the central nervous system, pituitary gland or hypothalamic-pituitary-adrenal axis
    3. Diabetes mellitus
    4. Pathological conditions affecting cortisol metabolism, including liver disease
    5. Chronic renal failure
    6. Alcoholism
    7. Obesity
    8. Anorexia nervosa/ starvation
    9. High estrogen states, including pregnancy or use of OCP

  • Patients taking medication which might alter the normal function of the hypothalamic-pituitary-adrenal axis. This category includes:

    1. Patients taking exogenous steroid medication which would suppress normal cortisol production.
    2. Patients taking medication which alters steroid metabolism, including barbiturates, phenytoin and rifampicin.
  • Patients who have a known history of allergy, sensitivity or any other form of reaction to dexamethasone will be excluded from this study as they would be at risk of further reaction to dexamethasone.
  • Patients who have previously been included in this study will be excluded from further recruitment.
  • Patients who will undergo lateral neck dissection in association with the thyroid surgery will be excluded from the study as they will experience greater pain levels.
  • Patients who participate in other clinical studies during this study or in the 14 days prior to admission to this study will be excluded

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Placebo Comparator: Placebo
Other: Placebo
2 ml of 0.9% Saline Solution administered intravenously at induction of anesthesia
Experimental: Dexamethasone
Drug: Dexamethasone
One dose of 8 mg of Dexamethasone intravenously at induction of anesthesia

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Plasma Cortisol level.
Time Frame: One, eight and twenty-four hours following Dexamethasone administration.
One, eight and twenty-four hours following Dexamethasone administration.

Secondary Outcome Measures

Outcome Measure
Time Frame
Incidence of postoperative nausea and vomiting.
Time Frame: Twenty-four hours following surgery.
Twenty-four hours following surgery.
Pain intensity measured on the visual analogue scale.
Time Frame: Twenty-four hours following surgery
Twenty-four hours following surgery
Plasma Estradiol level.
Time Frame: One, eight and twenty-four hours following dexamethasone administration.
One, eight and twenty-four hours following dexamethasone administration.
Plasma Progesterone level.
Time Frame: One, eight and twenty-four hours following dexamethasone administration
One, eight and twenty-four hours following dexamethasone administration
Plasma ACTH level
Time Frame: One, eight and twenty-four hours following dexamethasone administration.
One, eight and twenty-four hours following dexamethasone administration.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

St. Paul's Hospital, Canada

Investigators

  • Principal Investigator: Jill A Osborn, MD, St Paul's Hospital, Vancouver and University of British Columbia

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

May 1, 2010

Primary Completion (Anticipated)

February 1, 2014

Study Completion (Anticipated)

February 1, 2016

Study Registration Dates

First Submitted

January 8, 2010

First Submitted That Met QC Criteria

January 8, 2010

First Posted (Estimate)

January 11, 2010

Study Record Updates

Last Update Posted (Estimate)

April 19, 2016

Last Update Submitted That Met QC Criteria

April 18, 2016

Last Verified

April 1, 2016

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SPH-1515-DA

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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