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

18 april 2016 uppdaterad av: 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.

Studieöversikt

Status

Indragen

Betingelser

Intervention / Behandling

Detaljerad beskrivning

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.

Studietyp

Interventionell

Fas

  • Fas 4

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

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

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Kvinna

Beskrivning

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

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Fyrdubbla

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Placebo-jämförare: Placebo
Övrig: Placebo
2 ml of 0.9% Saline Solution administered intravenously at induction of anesthesia
Experimentell: Dexametason
Läkemedel: Dexamethasone
One dose of 8 mg of Dexamethasone intravenously at induction of anesthesia

Vad mäter studien?

Primära resultatmått

Resultatmått
Tidsram
Plasma Cortisol level.
Tidsram: One, eight and twenty-four hours following Dexamethasone administration.
One, eight and twenty-four hours following Dexamethasone administration.

Sekundära resultatmått

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

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

St. Paul's Hospital, Canada

Utredare

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

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 maj 2010

Primärt slutförande (Förväntat)

1 februari 2014

Avslutad studie (Förväntat)

1 februari 2016

Studieregistreringsdatum

Först inskickad

8 januari 2010

Först inskickad som uppfyllde QC-kriterierna

8 januari 2010

Första postat (Uppskatta)

11 januari 2010

Uppdateringar av studier

Senaste uppdatering publicerad (Uppskatta)

19 april 2016

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

18 april 2016

Senast verifierad

1 april 2016

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • SPH-1515-DA

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