This study aims to investigate how the timing of dexamethasone administration during anesthesia induction affects patient outcomes after surgery. Dexamethasone is commonly used to reduce nausea and inflammation during and after surgery. However, it is not yet known if administering dexamethasone at different times during induction (before, during, or after specific anesthetic drugs) leads to better recovery and fewer postoperative complications.

Participants will be randomly assigned to one of three groups: one group will receive dexamethasone before fentanyl, another after the muscle relaxant, and a third group will not receive dexamethasone. This approach will help us understand if the timing of dexamethasone affects patient outcomes such as nausea, pain, and recovery quality. The study is triple-blinded, meaning that the participants, care providers, and investigators will not know which group the participants are in, to ensure unbiased results.

This study explores the effects of different timings of dexamethasone administration during the induction phase of anesthesia on various postoperative outcomes. Dexamethasone is widely used in anesthesia practice to prevent postoperative nausea and vomiting (PONV) and to reduce inflammatory responses. However, the optimal timing of its administration has not been conclusively established, which may impact its effectiveness and patient recovery.

In this triple-blind randomized controlled trial, participants will be assigned to one of three intervention groups to receive dexamethasone at different times during anesthesia induction: (1) prior to fentanyl administration, (2) after administration of a muscle relaxant, or (3) no dexamethasone as a control group. We hypothesize that the timing of dexamethasone administration may influence outcomes such as incidence and severity of PONV, pain levels, time to recovery, and other potential complications.

By analyzing these parameters, the study seeks to establish an evidence-based guideline for the timing of dexamethasone administration to optimize postoperative recovery. The findings could inform anesthetic protocols and enhance patient outcomes in surgical settings.

Inclusion Criteria:

• Adults aged 18 years or older
• Scheduled for elective non cardiac surgery requiring general anesthesia
• surgery last at least 90 minutes
• scare of more than 5 cm Able to provide informed consent Eligible for dexamethasone administration as part of routine perioperative care

Exclusion Criteria:

• Known allergy or hypersensitivity to dexamethasone or related corticosteroids
• History of uncontrolled diabetes mellitus or significant blood glucose management issues, as dexamethasone may affect glucose levels
• Severe cardiovascular instability or hemodynamic issues contraindicating study participation
• Patients receiving immunosuppressive therapy or with conditions affecting the immune system, as corticosteroids may alter immune responses
• Pregnancy or breastfeeding, due to potential risks to the fetus or infant
• Current or recent (within 30 days) use of other glucocorticoids, which may interfere with study outcomes
• Patients with psychiatric or cognitive conditions that impair their ability to consent or adhere to study protocols
• Lack of informed consent

Currently, there are no plans to share individual participant data (IPD) from this study due to considerations around patient privacy and data confidentiality. Given the sensitive nature of perioperative health data and the need to ensure participant anonymity, data sharing will only be considered if adequate safeguards can be implemented. Additionally, sharing IPD requires comprehensive agreements on data access, use, and security, which are not in place at this time.

This study employs a triple-blinded design. Participants, care providers, investigators, and outcomes assessors are all blinded to the group assignments to prevent bias. Additionally, the study coordinators and data analysts responsible for interpreting results are also masked to maintain objectivity in data collection and analysis. Randomization is handled by an independent party, and group assignments are concealed until the completion of data analysis.