Adverse side effects of dexamethasone in surgical patients

Abstract

Background In the perioperative period, dexamethasone is widely and e ectively used for prophylaxis of postoperative nausea and vomiting (PONV), for pain management, and to facilitate early discharge a er ambulatory surgery. Long-term treatment with steroids has many side e ects, such as adrenal insu iciency, increased infection risk, hyperglycaemia, high blood pressure, osteoporosis, and development of diabetes mellitus. However, whether a single steroid load during surgery has negative e ects during the postoperative period has not yet been studied. Objectives To assess the e ects of a steroid load of dexamethasone on postoperative systemic or wound infection, delayed wound healing, and blood glucose change in adult surgical patients (with planned subgroup analysis of patients with and without diabetes). Search methods We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, and the Web of Science for relevant articles on 29 January 2018. We searched without language or date restriction two clinical trial registries to identify ongoing studies, and we handsearched the reference lists of relevant publications to identify all eligible trials. Selection criteria We searched for randomized controlled trials comparing an incidental steroid load of dexamethasone versus a control intervention for adult patients undergoing surgery. We required that studies include a follow-up of 30 days for proper assessment of the number of postoperative infections, delayed wound healing, and the glycaemic response. Data collection and analysis Two review authors independently screened studies for eligibility, extracted data from relevant studies, and assessed all included studies for bias. We resolved di erences by discussion and pooled included studies in a meta-analysis. We calculated Peto odds ratios (ORs) for dichotomous outcomes and mean di erences (MDs) for continuous outcomes. Our primary outcomes were postoperative systemic or wound infection, delayed wound healing, and glycaemic response within 24 hours. We created a funnel plot for the primary outcome postoperative (wound or systemic) infection. We used GRADE to assess the quality of evidence for each outcome.

Transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus (GDM) in preterm pregnant women receiving antenatal steroids

“…It was found that single course of dexamethasone resulted in acute increase in blood glucose level while multiple courses resulted in continuous increase in blood glucose levels. 13 In Our study 73.78% of study participants had deranged blood sugar level after dexamethasone therapy out of which 6.21 % developed GDM whereas 67.51% had transient hyperglycemia, similarly a study by Refuerzo et al showed 16% to 33% increase in glucose level at 20,44 and 68 hours after first dose of antenatal corticosteroids in pregnant women without diabetes which may be missed with conventional monitoring. 14 Glucose intolerance is signficantlty higher in twins and triplets compared to singleton.…”

Vogesella perlucida-induced bacteremia in an advanced-age patient: first case report

“…From the patient’s medical history, the 71-year old patient has many basic diseases, which means that immunity of the patient is relatively poor. In addition, the patient has abused dexamethasone for more than 10 years and long-term treatment with steroids can cause side effects, such as adrenal insufficiency, increased infection risk, hyperglycaemia, high blood pressure, osteoporosis, and so on [ 12 ]. As a result, the long-term abuse of dexamethasone makes the patient susceptible to infection.…”

Localized drug delivery graphene bioscaffolds for cotransplantation of islets and mesenchymal stem cells

“…Hence, to address this issue of the host inflammatory response to our graphene bioscaffold, we decided to functionalize our bioscaffold with Dex because it is an immunosuppressive glucocorticoid capable suppressing inflammatory pathways ( 35 ), as well as inhibiting the expression of many inflammatory mediators ( 36 ). This approach will enable us to precisely modulate the local microenvironment following bioscaffold implantation, thereby mitigating the need for intravenous administration of Dex which is often associated with significant systemic side effects, which include fluid retention (swelling in hands or ankles), headache, dizziness, increased blood pressure, and slow wound healing ( 37 , 38 ).…”