Upper airway edema after carotid endarterectomy: the effect of steroid administration

The objective of this study was to evaluate the effect of preoperative steroid administration on the site and extent of upper airway edema after carotid endarterectomy. The design was a randomized, prospective, double-blind controlled trial. Thirty-eight patients undergoing elective carotid endarterectomy (17 patients were in the steroid-treated group and 21 in the control group) were administered either 16 mg of dexamethasone or saline placebo prior to surgery. Computed tomograms (CT) scans of the neck were performed on the patients preoperatively and 24 h postoperatively. Measurements were taken from the CT scans of the airway transverse and anterior-posterior diameters at the levels of the hyoid bone, arytenoid cartilage, and cricoid cartilage. No postoperative neck hematomas were seen on the CT scans. Although neck edema was observed postoperatively, the upper airway dimensions were not statistically significantly different between the steroid and the control groups. We conclude that steroid administration immediately preoperatively has no clinical effect in reducing edema formation in the upper airway postcarotid endarterectomy.