Adverse side‐effects of dexamethasone in surgical patients – an abridged Cochrane systematic review

Abstract

In the peri-operative period, dexamethasone is widely and effectively used for prophylaxis of postoperative nausea and vomiting. The objective of this meta-analysis was to assess the adverse effects of an incidental steroid load of dexamethasone in adult surgical patients. We searched in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the Web of Science for randomised controlled trials comparing an incidental steroid load of dexamethasone with a control intervention in adult patients undergoing surgery. Two review authors independently screened studies for eligibility, extracted data and assessed all included studies for bias. Our primary outcomes were postoperative systemic or wound infection, delayed wound healing and glycaemic response within 24 h. We included 37 studies in this meta-analysis. The pooled results found no evidence that dexamethasone increased the risk of a postoperative wound infection, Peto OR (95%CI) 1.01 (0.80-1.27); 4603 participants, 26 studies; I² = 32%; moderate-quality evidence. Whether dexamethasone influenced wound healing was unclear due to the large confidence intervals, Peto OR (95%CI) 0.99 (0.28-3.43); 1072 participants, 8 studies; I² = 0%; low-quality evidence. Dexamethasone produced a mild increase in glucose levels among participants without diabetes during the first 12 h after surgery, mean difference (95%CI) 0.7 mmol.l À1 (0.3-1.2) 10 studies; 595 participants; I² = 50%; low-quality evidence. This article is an abridged version of a Cochrane Review.

The Magnitude of Dexamethasone-Induced Hyperglycemia in Cataract Surgical Patients with Normal Glucose Metabolism- A Continuous Glucose Monitoring Based Study

“…Corticosteroid associated hyperglycemia may have a pronounced peak glucose concentration after 9 to 12 hours [8,23], and gradually decrease to baseline or to normal after nocturnal period [11]. However, in this study, we did not observe a discernable trend of glycemic decrease from afternoon to next morning.…”

“…Furthermore, the higher incidence of glucocorticoid induced diabetes may signi cantly decrease after 30 months [6]. The magnitude and duration of dexamethasone induced glucose level increase may be mild and transient in patients without diabetes [7,8]. Importantly, researchers observed that patients without prior history of diabetes showing a comparable [9], or greater increase in glucose levels compared to those of patients with onset diabetes [10].…”

Basics and Best Practices of Multimodal Pain Management for the Plastic Surgeon

“…No evidence currently exists correlating dexamethasone use with an increased occurrence of postoperative wound infection or wound healing delay. 61 …”

Perineural adjuncts for peripheral nerve block

“…4 Dexamethasone has been associated with an increase in postoperative blood glucose concentration in diabetic and non-diabetic patients. 5 Concerns about the potential to cause delayed wound healing and systemic or wound infection have not been confirmed in a recent meta-analysis. In one RCT, the increase in mean serum glucose concentrations with perineural dexamethasone administration was clinically insignificant.…”