L aparoscopic cholecystectomy (LC) is one of the most often performed elective procedures, with up to 84% of patients being discharged on the day of the surgery. Clinical recovery, however, can be slowed by the metabolic, hormonal, inflammatory, and immune responses activated by even minimally invasive procedures. Dexamethasone (DEX) is effective, alone or in combination with other antiemetic agents, in reducing nausea and vomiting after laparoscopic procedures. The effect of this drug on quality of recovery after patients are discharged from the hospital after laparoscopic surgery has not been examined thoroughly. This randomized, double-blind, placebo-controlled study used a 40-item quality-of-recovery scoring system to assess the quality of recovery on postoperative day (POD) 1 as reported by the patient.The 120 patients undergoing outpatient LC were randomized to receive either 8 mg DEX or placebo-saline. Dexamethasone or placebo was administered over 60 to 90 seconds to avoid the unpleasant symptoms that can occur after rapid injection of DEX. Anesthetic management included induction with propofol, rocuronium, and fentanyl, with maintenance with sevoflurane. Mechanical ventilation maintained an end-tidal CO 2 concentration of 30 to 34 mm Hg using a 50% oxygen-air gas mixture. Neuromuscular blockade was reversed with 50 Kg/kg neostigmine and glycopyrrolate before tracheal extubation. All patients received 4 mg ondansetron 30 minutes before the end of the surgery. Laparoscopic cholecystectomy was achieved using 4 punctures of the abdomen. The effect of DEX on nausea, vomiting, pain, and fatigue was determined. The baseline QoR-40 questionnaire was provided to patients in the preoperative ambulatory surgical unit. The 5 general quality-of-life dimensions assessed are physical comfort, emotional state, physical independence, psychological support, and pain. Each item of the 40 total is graded on a 5-point Likert scale, with global scores ranging from 40 (extremely poor quality of recovery) to 200 (excellent quality of recovery). Patients were also told they would have the questionnaire 24 hours after leaving the ambulatory surgical unit, that is, on POD 1.The primary end point of the study was the QoR-40 score on POD 1.The LC was converted to an open procedure in 5 patients, 3 receiving DEX and 2 in the control group; they were excluded from the analysis. The remaining patients in the 2 groups did not differ in age, weight, height, sex, preexisting medical conditions, American Society of Anesthesiologists physical status, presence or absence of symptoms of nausea, vomiting, fatigue, or pain in the immediate preoperative period. The groups also did not differ in any intraoperative variables. Baseline global and dimensional scores on the questionnaire completed preoperatively did not differ between the groups. On POD 1, global scores were lower in the control group than the DEX group (161 vs 178), indicating a poorer quality of recovery in the control patients. Scores in the dimensions of emotional state, physica...