Njall Pouth Clotilde^1*, Charles Emmanuel Toussaint Binam Bikoi⁴, Serge Vivier Nga Nomo³, Mbango-Ekouta Noel Désirée¹, Ebana Steve¹, Amengle ludovic², Binam Fidèle³

¹Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon

²Faculty of Biomedical Sciences, University of Yaoundé I, Cameroon

³Department of Anesthesia and Intensive Care, Catholic University of Central Africa, Yaoundé, Cameroon

⁴Department of Anesthesia and Intensive Care, University of Ebolowa, Ebolowa, Cameroon

^* Corresponding Author: Dr Clotilde Njall pouth, Faculty of Medicine and Pharmaceutical Sciences, Department of Surgery and Specialties, University of Douala. Anesthesiologist – Intensivist, Cameroon.

Received: 13 September 2025; Accepted: 22 September 2025; Published: 25 February 2026

Article Information

Citation: Njall Pouth Clotilde, Charles Emmanuel Toussaint Binam Bikoi, Serge Vivier Nga Nomo, Mbango-Ekouta Noel Désirée, Ebana Steve, Amengle ludovic, Binam Fidèle. Association Between Body Mass, Dexamethasone Antiemetic Prophylaxis, and the Occurrence of Postoperative Nausea and Vomiting. Anesthesia and Critical care 8 (2026): 25-29.

DOI: 10.26502/acc.097

Abstract

Keywords

Body mass; Dexamethasone antiemetic prophylaxis; Postoperative nausea and vomiting

Article Details

1. Introduction

Postoperative nausea and vomiting (PONV) are among the most common and distressing postoperative complications, affecting up to 30% of patients according to statistics [1-3]. Beyond the discomfort they cause, PONV may prolong hospitalization, increase the risk of respiratory complications, delay the resumption of oral intake, and raise healthcare costs [4]. Various preventive strategies have therefore been developed, ranging from anesthetic optimization (use of less emetogenic agents, reduction of opioids) to targeted administration of antiemetics such as 5-HT3 antagonists, metoclopramide, or anticholinergics [5]. Among these, dexamethasone antiemetic prophylaxis (a corticosteroid) is increasingly recommended due to its effectiveness, low cost, and simple single-dose preoperative administration [6]. Its use has significantly expanded in many modern anesthesia protocols, thanks to its generally favorable safety profile and the possibility of combining it with other antiemetics for synergistic effect [7]. However, some limitations remain, such as its potential impact on blood glucose and immunity, or its reduced effectiveness in certain patient groups [8-10].

Regarding its efficacy, several studies and meta-analyses confirm that dexamethasone significantly reduces the incidence of PONV compared to no prophylaxis or certain isolated treatments [11-15]. Nonetheless, various individual risk factors, such as history of motion sickness, sex, age, or body mass, may influence its effectiveness. In particular, body mass may play a role through multiple biological, cellular, and molecular mechanisms: changes in the volume of distribution of dexamethasone, metabolic alterations linked to excess adipose tissue, modifications in inflammatory profile, and endocrine dysregulations associated with obesity [16]. These mechanisms can lead to inappropriate plasma concentrations of the drug or variable pharmacodynamic responses, resulting in unequal prophylactic efficacy among patients at weight extremes [17].

Thus, investigating the association between body mass and the protective effect of dexamethasone against PONV is of major clinical interest, as it may help optimize preventive protocols and promote individualized, safer, and more effective care. This is precisely the objective of the present study: to understand the extent to which body mass influences dexamethasone antiemetic prophylaxis and, ultimately, to improve PONV prevention strategies for better quality of care.

2. Patients and Methods

2.1 Study Type, Period, and Setting

We conducted a case-control study from March to May 2015 at Laquintinie Hospital, Douala (HLD). It included patients operated on in the ENT, traumatology, and gynecology departments, aiming to determine whether PONV prevention depends on body mass among patients who received dexamethasone antiemetic prophylaxis (DAP).

2.2 Study Population

The study population comprised 105 patients operated on in ENT, traumatology, and gynecology departments, divided into 58 cases and 54 controls. Cases were defined as patients who received DAP, and controls as those who did not. Both groups were matched for age and sex. To distinguish cases from controls, consecutive numbers were assigned to patients: odd numbers corresponded to those receiving DAP, while even numbers corresponded to those not receiving it.

2.3 Data Collection Procedure

Data were collected using a predesigned anonymous survey form, completed from medical records and clinical observation. Body mass was measured through a series of weighings using a SECA 797 scale. Before each measurement, the scale was checked for proper calibration and stability on a flat surface. Patients removed shoes and heavy objects to avoid bias. They carefully stepped on the scale, remained still, and looked straight ahead. Once the value stabilized, body mass was recorded in kilograms with a precision of ±100 g. Between measurements, the zero point was checked, ensuring patients did not lean on any support. The same procedure was applied in cases before DAP administration and in controls (dosage: 4 mg for patients weighing <60 kg and 8 mg for those >60 kg). PONV occurrence was assessed within 48 hours postoperatively.

2.4 Ethical Considerations

Ethical principles were strictly observed. Authorization was obtained from the management of Laquintinie Hospital. Patients, or their legal representatives, were informed about the study’s nature and objectives, and provided free and informed consent. Participation was voluntary and could be withdrawn at any time. Confidentiality was ensured by anonymized survey forms, and the database was accessible only to investigators and supervisors.

2.5 Data Analysis

Data were entered and analyzed using R software version 4.4.2 for Windows and presented as frequencies and percentages. Pearson’s chi-square test with Fisher’s correction was performed to evaluate the association between body mass, DAP, and PONV occurrence, with significance set at 5%.

3. Results

3.1 Association between Body Mass, DAP, and PONV Occurrence in Cases and Controls

PONV was generally more frequent among controls, particularly in the weight ranges [50–59] kg (33.3%), [60–69] kg (39.1%), and [70–79] kg (35.7%), compared with cases. In the [60–69] kg group, a statistically significant difference was observed (p = 0.036), with a higher proportion of PONV in controls (39.1%) compared to cases (9.5%). No statistically significant difference was found in the other weight ranges (p > 0.05) (Table 1).

Table 1: Study of the association between body mass, dexamethasone antiemetic prophylaxis (DAP), and the occurrence of postoperative nausea and vomiting (PONV) in cases and controls.

4. Discussion

The results of our study indicate that DAP is associated with an overall reduction in the frequency of PONV, with a particularly significant effect in the [60–69] kg weight range. In this group, the percentage of PONV decreased from 39.1% in controls (without DAP) to 9.5% in cases (with DAP), yielding a statistically significant difference (p = 0.036). These findings support the hypothesis that the effectiveness of DAP may be influenced by body mass, possibly due to specific pharmacokinetic and pharmacodynamic mechanisms [17].

Previous research has documented the overall efficacy of dexamethasone in preventing PONV, regardless of anesthetic strategy [7,13]. These studies notably highlight a significant reduction in PONV risk in patients who received a single preoperative dose of dexamethasone. In our study, the marked difference observed in the [60–69] kg group extends these findings and suggests that body mass could be an important determinant of the response to dexamethasone. It should be noted that some studies have focused on the influence of BMI rather than total body mass [2]. However, our results clearly show that simple stratification by weight ranges can already reveal variability in the effectiveness of antiemetic prophylaxis.

Several mechanisms may explain why patients within the mid-range of body mass (here [60–69] kg) respond better to DAP. On the one hand, the volume of distribution of dexamethasone may be more favorable in this group, maintaining optimal plasma concentrations of the corticosteroid [17]. On the other hand, metabolic changes associated with weight extremes (very low weight <50 kg or high weight >100 kg) may alter hepatic metabolism and dexamethasone clearance [18]. It is plausible that in these extreme ranges, the plasma concentration required to prevent PONV is not always achieved or maintained, thereby reducing effectiveness. Moreover, inflammation and immune response vary with body mass, and different levels of inflammatory cytokines may modulate corticosteroid responsiveness [19].

In the other weight ranges, a trend was also observed toward a higher incidence of PONV among controls than cases. However, these differences were not statistically significant, which may be explained by sample size or a less pronounced effect of DAP in these weight categories. For example, in the [50–59] kg group, the sample size was limited (p = 0.261), making interpretation difficult [5]. Similarly, in patients weighing [70–79] kg, despite frequency differences (35.7% PONV in controls vs. 11.8% in cases), the p-value of 0.198 prevents concluding statistical dependence. Finally, extreme weight ranges (<50 kg, [90–99] kg, and >100 kg) had such small numbers that no robust conclusions could be drawn [4].

An important strength of this study lies in its case-control design, directly comparing the effect of DAP between two homogeneous groups while accounting for the variable “body mass.” However, not considering in detail other PONV risk factors (such as history of motion sickness, sex, or opioid use) represents a limitation. Furthermore, evaluating body mass alone, without calculating BMI or measuring body composition, may overlook determinants linked to fat and muscle distribution [2].

From a clinical perspective, our data suggest that personalization of dexamethasone dosing could be considered, particularly for patients whose body mass may modulate plasma drug concentration [20]. In addition, combining dexamethasone with other classes of antiemetics (5-HT3 antagonists, NK1 antagonists, etc.) could be especially effective in high-risk patients, whether due to extreme weight or associated comorbidities [7].

5. Conclusion

Our study highlights a significant relationship between body mass, administration of DAP, and the occurrence of PONV, mainly in the [60–69] kg weight group. The underlying mechanisms likely involve variations in distribution volume, hepatic metabolism, and inflammatory response. Further research, including more precise methods of body composition assessment and larger sample sizes, is warranted to better define the role of body mass in DAP effectiveness and ultimately optimize PONV prevention.

6. Declarations

Statements on Human Ethics and Consent to Participate

• • Ethical Approval

Ethical approval was obtained from the Ethics Committee of the University of Douala, Cameroon and authorized by the management of Laquintinie Hospital in Douala

• • Consent to Participate

All participants provided informed consent before their inclusion in the study. The consent process ensured that participants fully understood the purpose of the research, their role in the study, and their rights, including the right to withdraw at any time without any negative consequences

• • Confidentiality

The privacy and confidentiality of all participants were safeguarded throughout the study. Data were anonymized to ensure that no participant could be identified

Availability of Data and Materials

The data used in this study can be made available upon request by the reviewers

Competing interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be interpreted as a potential conflict of interest.

Funding

The authors declare that the research was conducted without external funding.

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