Overview
Inflammation of the large intestine can be a significant component of the pathophysiological response to surgical stress, potentially prolonging recovery 1. This inflammatory response can be measured by markers such as C-reactive protein (CRP) 1.
Diagnosis
C-reactive protein (CRP) levels can be used to assess the inflammatory response postoperatively 1.Management
Preoperative high-dose intravenous dexamethasone (1 mg/kg) may reduce CRP levels on postoperative day 1 following emergency laparotomy 1.
Dexamethasone administration in this setting has been associated with improved recovery, including better hemodynamics, pulmonary function, less fatigue, and earlier mobilization 1.
Stratification by surgical pathology (intestinal obstruction vs. perforated viscus) showed reduced CRP levels with dexamethasone in both groups 1.Key Recommendations
Consider a single preoperative high dose of intravenous dexamethasone (1 mg/kg) in patients undergoing emergency laparotomy to reduce postoperative C-reactive protein levels 1. (Evidence: Strong)
Preoperative high-dose dexamethasone may improve postoperative recovery, including hemodynamic stability, pulmonary function, and patient mobilization 1. (Evidence: Strong)References
1 Cihoric M, Kehlet H, Lauritsen ML, Højlund J, Kanstrup K, Kärnsund S et al.. Preoperative high dose of dexamethasone in emergency laparotomy: randomized clinical trial. The British journal of surgery 2024. link