Adverse side effects of dexamethasone in surgical patients

Polderman, J; Farhang-Razi, Violet; Dieren, Susan van; Kranke, Peter; DeVries, J. Hans; Hollmann, Markus W.; Preckel, Benedikt; Hermanides, Jeroen

doi:10.1002/14651858.cd011940.pub2

Cited by 88 publications

(94 citation statements)

References 97 publications

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“…Therefore, we stratified our randomization per centre. Consistent with the literature, we observed higher BG concentrations in the patients treated with corticosteroids . None the less, the efficacy of liraglutide was comparable, whether patients received intraoperative corticosteroids or not.…”

Section: Discussionsupporting

confidence: 91%

Liraglutide for perioperative management of hyperglycaemia in cardiac surgery patients: a multicentre randomized superiority trial

Hulst

Visscher

Godfried

et al. 2019

Diabetes Obesity Metabolism

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Aims Most cardiac surgery patients, with or without diabetes, develop perioperative hyperglycaemia, for which intravenous insulin is the only therapeutic option. This is labour‐intensive and carries a risk of hypoglycaemia. We hypothesized that preoperative administration of the glucagon‐like peptide‐1 receptor agonist liraglutide reduces the number of patients requiring insulin for glycaemic control during cardiac surgery. Materials and methods In this randomized, blinded, placebo‐controlled, parallel‐group, balanced (1:1), multicentre randomized, superiority trial, adult patients undergoing cardiac surgery in four Dutch tertiary hospitals were randomized to receive 0.6 mg subcutaneous liraglutide on the evening before surgery and 1.2 mg after induction of anaesthesia or matching placebo. Blood glucose was measured hourly and controlled using an insulin‐bolus algorithm. The primary outcome was insulin administration for blood glucose >8.0 mmol/L in the operating theatre. Research pharmacists used centralized, stratified, variable‐block, randomization software. Patients, care providers and study personnel were blinded to treatment allocation. Results Between June 2017 and August 2018, 278 patients were randomized to liraglutide (139) or placebo (139). All patients receiving at least one study drug injection were included in the intention‐to‐treat analyses (129 in the liraglutide group, 132 in the placebo group). In the liraglutide group, 55 (43%) patients required additional insulin compared with 80 (61%) in the placebo group and absolute difference 18% (95% confidence interval 5.9–30.0, P = 0.003). Dose and number of insulin injections and mean blood glucose were all significantly lower in the liraglutide group. We observed no difference in the incidence of hypoglycaemia, nausea and vomiting, mortality or postoperative complications. Conclusions Preoperative liraglutide, compared with placebo, reduces insulin requirements while improving perioperative glycaemic control during cardiac surgery.

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Section: Discussionsupporting

confidence: 91%

Liraglutide for perioperative management of hyperglycaemia in cardiac surgery patients: a multicentre randomized superiority trial

Hulst

Visscher

Godfried

et al. 2019

Diabetes Obesity Metabolism

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“…However, there was only infrequent reporting of wound infections and wound healing complications in the studies included in our review. Recently, Polderman et al concluded that a single dose of dexamethasone does not affect the risk of infections, whereas no definite conclusion was possible for delayed wound healing. In conclusion, our analysis provides solid evidence for the notion that i.v.…”

Section: Discussionmentioning

confidence: 99%

Effect of intravenous dexamethasone on postoperative pain after spinal anaesthesia – a systematic review with meta‐analysis and trial sequential analysis

et al. 2019

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There are data suggesting that intravenous dexamethasone has an effect on postoperative analgesia when given during single-shot spinal anaesthesia. However, the research literature is equivocal. We performed a systematic literature search followed by conventional meta-analysis (random effects model). We used trial sequential analysis to control for type-1 and -2 statistical errors. We also performed a leave-one-out metaanalysis for our primary outcome, the consumption of intravenous morphine in the first 24 postoperative hours. We applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to rate the level of evidence. We obtained data from 1133 patients, reported in 17 trials. Reporting quality was high, with low risk of bias. Dexamethasone use was associated with a significant reduction in 24-h morphine consumption, the mean difference (95%CI) being À4.01 (À5.01 to À3.01) mg, 6 trials, 326 participants, I 2 = 0%. Trial sequential analysis showed that there was firm evidence for the primary outcome, and leave-one-out metaanalysis showed that our result was not driven by one single trial. The GRADE evaluation showed a high level of evidence, suggesting that further studies are unlikely to alter the result. The time to first analgesic request (95% CI) was significantly prolonged by 86.62 (10.62-162.62) min, I 2 = 93%, in the dexamethasone group. For other secondary outcomes including number of patients requiring rescue analgesia, or visual analogue scale pain scores, we found no evidence of a significant difference between the treatment arms. We report a high level of evidence that intravenous dexamethasone improves postoperative analgesia after spinal anaesthesia.

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“…The use of dexamethasone for PONV is well‐established, but its use remains debated in the medical literature due to potential for side effects including poor wound healing and hyperglycemia. A recent meta‐analysis of dexamethasone in surgical patients found no increase in the risk of postoperative infection (OR 1.01, 95% CI 0.80‐1.27), but were unable to examine the effect on wound healing due to the imprecision in the available randomized trials . Dexamethasone was found to have a mild increased in glucose in patients without diabetes for the first 12 hours after surgery (mean difference 13 mg/dL, 95% CI 6‐21).…”

Section: Discussionmentioning

confidence: 99%

Incidence and predictors of postoperative nausea and vomiting in children undergoing electrophysiology ablation procedures

Lee

Banooni

Yuki

et al. 2020

Pediatric Anesthesia

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Background Postoperative nausea and vomiting remains a significant concern for patients undergoing general anesthesia for percutaneous radiofrequency catheter ablation and cryoablation for tachyarrhythmias. Aim Our objective was to examine the incidence and risk factors for nausea and vomiting in the recovery room. Methods Children aged > 2 and ≤ 18 years who underwent general anesthesia for a percutaneous radiofrequency catheter ablation or cryoablation for a tachyarrhythmia between January 1, 2013, and January 1, 2016, were retrospectively reviewed. Outcomes included postoperative nausea, vomiting, and a composite of postoperative nausea and vomiting in the recovery room. Results We identified 611 patients with a mean age of 13.3 ± 3.9 years, 54.5% male, and a mean length of anesthesia was 3.9 ± 1.0 hours. Vomiting or retching in the postanesthesia care unit occurred in 7.4% of patients and nausea in an additional 12.4%. A composite of nausea and vomiting occurred in 95 patients (15.5%). On multivariable analysis, a subhypnotic propofol infusion (OR 0.45, 95% CI 0.23‐0.88, P = .019) and shorter anesthetic duration (OR 0.81 per 30 minutes, 95% CI 0.70‐0.94, P = .006) were independently associated with less vomiting in the recovery room. A history of PONV (OR 2.24, 95% CI 1.24‐4.05, P = .007) was independently associated with a composite of nausea and vomiting in the recovery room. Conclusions A shorter anesthetic time and a subhypnotic propofol infusion were predictive of a lower rate of postoperative vomiting in patients undergoing general anesthesia for electrophysiologic ablation procedures.

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Adverse side effects of dexamethasone in surgical patients

Cited by 88 publications

References 97 publications

Liraglutide for perioperative management of hyperglycaemia in cardiac surgery patients: a multicentre randomized superiority trial

Liraglutide for perioperative management of hyperglycaemia in cardiac surgery patients: a multicentre randomized superiority trial

Effect of intravenous dexamethasone on postoperative pain after spinal anaesthesia – a systematic review with meta‐analysis and trial sequential analysis

Incidence and predictors of postoperative nausea and vomiting in children undergoing electrophysiology ablation procedures

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