The Effect of Timing of Dexamethasone Administration on Its Efficacy as a Prophylactic Antiemetic for Postoperative Nausea and Vomiting

Wang, Jhi-Joung; Ho, Shung‐Tai; Tzeng, Jann-Inn; Tang, Chao-Shun

doi:10.1213/00000539-200007000-00025

Cited by 201 publications

(93 citation statements)

References 21 publications

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“…The exact dose and timing of prophylactic glucocorticoid remain unknown. It appears as though dexamethasone is most effective when given immediately before induction of anesthesia rather than at the end of surgery [25]. Doseranging studies support a minimum effective dose of approximately 5 mg dexamethasone in nonorthopaedic surgeries to decrease the incidence of postoperative nausea and vomiting [9,15,24].…”

Section: Discussionmentioning

confidence: 99%

Perioperative Dexamethasone Does Not Affect Functional Outcome in Total Hip Arthroplasty

Bergeron

Kardash

Huk

et al. 2009

Clin Orthop Relat Res

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Current trends in orthopaedic surgery have explored different forms of adjuvant treatments to minimize postoperative pain and the risk of nausea and vomiting. A small single preoperative dose of dexamethasone, as part of a comprehensive multimodal analgesic regimen in low-risk patients undergoing total hip arthroplasty (THA), provides antiemetic and opioid-sparing effects but the longer-term effects on pain, complications, or function are not known. We therefore asked whether such a routine would affect longer-term pain, complications, or function. Fifty patients undergoing elective primary THA using spinal anesthesia were initially randomized to receive either dexamethasone (40 mg intravenous) or saline placebo. The patients, anesthesiologists, nurses, and research coordinators were blinded to the study arms. The functional outcome was measured using the Harris hip score. Outcomes were assessed 6 weeks and 1 year postoperatively. We observed no difference in resting pain between the two groups at either time period.

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Section: Discussionmentioning

confidence: 99%

Perioperative Dexamethasone Does Not Affect Functional Outcome in Total Hip Arthroplasty

Bergeron

Kardash

Huk

et al. 2009

Clin Orthop Relat Res

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“…37 More recently, smaller doses (2.5-5 mg) have been found to be effective (IIIA). 80,82 In a meta-analysis, Henzi suggested that dexamethasone might be particularly effective against late PONV with a NNT of 4.3 for the prevention of late nausea and vomiting. 37 Dexamethasone appears to be most effective when administered prior to induction of anesthesia rather than at the end in preventing early PONV (0-2 hr); (IIIA).…”

Section: A Steroidsmentioning

confidence: 99%

“…37 Dexamethasone appears to be most effective when administered prior to induction of anesthesia rather than at the end in preventing early PONV (0-2 hr); (IIIA). 82 There are no reports of dexamethasone related adverse effects in the doses used for the management of PONV (IIA). 37 …”

Section: A Steroidsmentioning

confidence: 99%

Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

Can J Anesth/J Can Anesth

195

105

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P Pu ur rp po os se e: : To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).S So ou ur rc ce e: : Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.C Co on nc cl lu us si io on n: : PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature. Objectif : Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO). Source : Les publications d'essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l'opinion d'experts sur le traitement des NVPO. Constatations principales : L'origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l'anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n'est pas rentable. L'identification des patients à haut risque de NVPO permet

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“…When used as single agent prophylaxis for total abdominal hysterectomy, it is more effective when given before induction, rather than before the patient's emergence from anesthesia (14). Dose ranging studies have shown that doses less than 5 mg are not more efficacious than placebo (15).…”

Section: Discussionmentioning

confidence: 99%

Does intravenous dexamethasone prevent nausea and vomiting after reduction mammoplasty?

et al. 2002

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The Effect of Timing of Dexamethasone Administration on Its Efficacy as a Prophylactic Antiemetic for Postoperative Nausea and Vomiting

Cited by 201 publications

References 21 publications

Perioperative Dexamethasone Does Not Affect Functional Outcome in Total Hip Arthroplasty

Perioperative Dexamethasone Does Not Affect Functional Outcome in Total Hip Arthroplasty

Evidence-based management of postoperative nausea and vomiting: a review

Does intravenous dexamethasone prevent nausea and vomiting after reduction mammoplasty?

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