Efficacy of dexamethasone pretreatment on prevention of opioid-induced cough during anesthetic induction: A trial-sequential meta-analysis.

BACKGROUND

Opioid-induced cough (OIC) during anesthetic induction represents a significant clinical challenge with potential adverse physiological effects. Although dexamethasone has emerged as a potential preventive agent, individual studies have shown inconsistent results. This meta-analysis aimed to evaluate the efficacy of dexamethasone pretreatment in preventing OIC during anesthetic induction.

METHODS

We conducted a systematic search of the Medline, EMBASE, Cochrane Library, and Google Scholar databases from inception to December 2024. Randomized controlled trials comparing dexamethasone pretreatment with placebo or no treatment in adult patients undergoing general anesthesia were included. The primary outcome was the overall incidence of OIC. Secondary outcomes included the severity of cough, which was categorized as mild, moderate, or severe.

RESULTS

Seven randomized controlled trials involving 591 patients were included. In these studies, dexamethasone dosages ranged from 0.1 to 0.15 mg/kg or fixed 10 mg, administered 1 to 5 minutes before opioid administration. Dexamethasone pretreatment significantly reduced the overall incidence of OIC compared to the control (risk ratio [RR]: 0.48, 95% confidence interval [CI]: 0.26-0.87, P = .02, I2 = 91%). For secondary outcomes, dexamethasone showed no significant effect on mild cough (RR: 0.75, 95% CI: 0.41-1.37, P = .35, I2 = 66%) and severe cough (RR: 0.28, 95% CI 0.08-0.99, P = .05, I2 = 0%), but significantly reduced moderate cough (RR: 0.45, 95% CI 0.29-0.71, P = .0005, I2 = 0%). All included studies demonstrated a low risk of bias, although funnel plot analysis suggested potential publication bias. Trial sequential analysis suggests that the current evidence base remains insufficient to draw firm conclusions.

CONCLUSION

Dexamethasone pretreatment effectively reduced the overall incidence of OIC during anesthetic induction, with particular efficacy in preventing moderate cases. These findings support the use of dexamethasone as a preventive strategy in anesthetic practice, particularly for patients at a higher risk of complications from cough episodes. Because the current evidence remains inconclusive, further studies are needed to confirm these findings, determine optimal dosing strategies, and assess the effectiveness in broader patient populations beyond American Society of Anesthesiologists I-II status.