Excruciating Perineal Pain after Intravenous Dexamethasone

Neff, S. P. W.; Stapelberg, Francois; Warmington, A

doi:10.1177/0310057x0203000319

Cited by 45 publications

(24 citation statements)

References 11 publications

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“…However, because operations involving the scalp. pre-induction dexamethasone has reportedly caused perineal discomfort due to the injection solution containing phosphate, [156,157] …”

Section: Burn Surgerymentioning

confidence: 99%

Management of Postoperative Nausea and Vomiting in Children

Kovac

2007

Pediatric Drugs

115

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Postoperative nausea and vomiting (PONV) continues to be a frequent and important cause of morbidity in children. Postoperative vomiting (POV) is more commonly studied in children than postoperative nausea because of a child's inability to effectively express distress after experiencing nausea. POV is problematic in children and is one of the leading postoperative complaints from parents and the leading cause of readmission to the hospital. POV occurs twice as frequently in children as in adults, increasing until puberty and then decreasing to adult incidence rates. Gender differences are not seen before puberty. POV remains a main cause of morbidity in children because severe vomiting can be associated with dehydration, postoperative bleeding, pulmonary aspiration, and wound dehiscence. While children have an increased potential for dehydration and the resulting physiologic impairments, other associated results such as a delay in hospital discharge or an overnight or longer hospital admission also must be considered. The two most common emetogenic surgical procedures evaluated in children are strabismus repair and adenotonsillectomy. The approach to the management of PONV and POV in children is similar to that in adults. However, as the rate of POV is more frequent in children than in adults, more children are candidates for antiemetic prophylaxis. The management approach is multifactorial and involves proper preoperative preparation, risk stratification, rational selection of antiemetic prophylaxis, choice of anesthesia technique, and a plan for postoperative antiemetic therapy. It is important to identify children at moderate-to-high risk for POV as prophylactic antiemetic therapy is useful in these children. Antiemetics of choice for POV in children include dexamethasone, dimenhydrinate, perphenazine, ondansetron, dolasetron, granisetron, and tropisetron. The serotonin (5-hydroxytryptamine; 5-HT(3)) antagonists are the antiemetic drugs of first choice for POV prophylaxis in children because as a group they have greater efficacy for preventing vomiting than nausea. The 5-HT(3) antagonists can be effectively combined with dexamethasone with an increase in efficacy. If possible, regional anesthesia should be considered. For those undergoing general anesthesia, the baseline POV risk should be reduced. Children at moderate-to-high PONV risk should receive combination therapy with two or three prophylactic antiemetics from different antiemetic drug classes. Reference to and the use of PONV guidelines and management algorithms help improve cost-effective postoperative care.

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“…However, because operations involving the scalp. pre-induction dexamethasone has reportedly caused perineal discomfort due to the injection solution containing phosphate, [156,157] …”

Section: Burn Surgerymentioning

confidence: 99%

Management of Postoperative Nausea and Vomiting in Children

Kovac

2007

Pediatric Drugs

115

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“…The use of the steroids was short term and balanced against the risk of reoperation, parental nutrition and prolonged hospitalization. Rapid infusion of dexamethasone by a single shot is to be avoided in the conscious patient due to the incidence of severe perineal discomfort [11]. Slow infusion over 1 h is recommended.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal tract obstruction secondary to post-operative oedema: does dexamethasone administration help?

et al. 2016

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Oedema can occur in handled tissues following upper gastrointestinal surgery with anastomosis formation. Obstruction of the lumen may result in delayed return of enteric function. Intravenous steroid use may be beneficial. Three cases of delayed emptying following fundoplication, gastro-enteric and entero-enteric anastomoses are reviewed. Conservative management with supportive measures failed. Dexamethasone was administered to treat the oedematous obstruction. A literature review in PubMed, Cochrane database and Medline for English language publications on the use of dexamethasone in the treatment of acute post surgical oedema of the upper gastrointestinal was conducted. Administration of dexamethasone led to resolution of symptoms and successful outcome. No reports on the use of steroids in this context were identified in the literature. The use of dexamethasone may effectively treat intestinal obstruction due to inflammatory or oedematous cause in the early post-operative period.

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“…44 When dexamethasone is administered intravenously for PONV prophylaxis, the major adverse effects associated are perineal pain, and hyperglyclaemia in patients with diabetes. [45][46][47] The mechanism of perineal pain is obscure.…”

Section: Postoperative Nausea and Vomitingmentioning

confidence: 99%