Dexamethasone Antiemesis and Side-Effects

Allan, S G; Leonard, Robert

doi:10.1016/s0140-6736(86)91305-x

Cited by 22 publications

(5 citation statements)

References 4 publications

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“…A second target to decrease LOS was postoperative nausea, as seen by Park et al 13 Targeting nausea, an antiemetic was included in the postprotocol group as an intravenous or oral dexamethasone taper over 3 days. 24 This would primarily be administered intravenously and transitioned to oral as the patient was able to tolerate. Dosing was variable based on patient weight and intraoperative findings including, subjectively, the amount of blood that entered the subarachnoid space and if the cerebellar tonsils were shrunk with electrocautery.…”

Section: Discussionmentioning

confidence: 99%

Standardizing postoperative care for pediatric intradural Chiari decompressions to decrease length of stay

Mazur-Hart

Bowden

Pang

et al. 2021

Journal of Neurosurgery: Pediatrics

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OBJECTIVE Amid national and local budget crises, cutting costs while maintaining quality care is a top priority. Chiari malformation is a relatively common pediatric neurosurgical pathology, and postoperative care varies widely. The postoperative course can be complicated by pain and nausea, which can extend the hospital stay. In this study, the authors aimed to examine whether instituting a standardized postoperative care protocol would decrease overall patient hospital length of stay (LOS) as well as cost to families and the hospital system. METHODS A retrospective study of pediatric patients who underwent an intradural Chiari decompression with expansile duraplasty at a single institution from January 2016 to September 2019 was performed. A standardized postoperative care protocol was instituted on May 17, 2018. Pre- and postprotocol groups were primarily analyzed for demographics, LOS, and the estimated financial expense of the hospital stay. Secondary analysis included readmissions, opioid consumption, and follow-up. RESULTS The analysis included 132 pediatric patients who underwent an intradural Chiari decompression with expansile duraplasty. The preprotocol group included 97 patients and the postprotocol group included 35 patients. Patient age ranged from 0.5 to 26 years (mean 9.5 years). The mean LOS preprotocol was 55.48 hours (range 25.90–127.77 hours), and the mean postprotocol LOS was 46.39 hours (range 27.58–77.38 hours). The comparison between means showed a statistically significant decrease following protocol initiation (95% CI 1.87–16.31 hours, p = 0.014). In the preprotocol group, 21 of 97 patients (22%) were discharged the first day after surgery compared with 14 of 35 patients (40%) in the postprotocol group (p = 0.045). The estimated cost of one night on the pediatric neurosurgical intermediate ward was approximately $4500, which gives overall cost estimates for 100 theoretical cases of $927,800 for the preprotocol group and $732,900 for the postprotocol group. CONCLUSIONS By instituting a Chiari protocol, postoperative LOS was significantly decreased, which resulted in decreased healthcare costs while maintaining high-quality and safe care.

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Section: Discussionmentioning

confidence: 99%

Standardizing postoperative care for pediatric intradural Chiari decompressions to decrease length of stay

Mazur-Hart

Bowden

Pang

et al. 2021

Journal of Neurosurgery: Pediatrics

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“…An extensive Medline and internet search revealed several reports of perineal pain associated with intravenous glucocorticoids [5][6][7][8][9][10] , none of which had been reported in the anaesthetic literature. Four reports, with a total of 60 patients, concerned dexamethasone 5,[7][8][9] . In all the latter reports, moderate to high intravenous doses of dexamethasone (between 12 mg 5 and 200 mg 7 ) were used to prevent and treat chemotherapeutic-associated nausea and vomiting.…”

Section: Discussionmentioning

confidence: 99%

“…This pain appears to be short-lived and at present it is unclear if fentanyl significantly shortens the duration. Most reports suggest that a slow rate of administration of dexamethasone can minimize or even abolish this side-effect [5][6][7][8] .…”

Section: Discussionmentioning

confidence: 99%

Excruciating Perineal Pain after Intravenous Dexamethasone

Neff¹,

Stapelberg²,

Warmington³

2002

Anaesth Intensive Care

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We describe two cases of unexpected perineal pain immediately after intravenous injection of fentanyl and dexamethasone (100 µg and 8 mg respectively) during induction of general anaesthesia. In both cases the pain was immediate (onset within 30 seconds), severe, localized to the genital region and of shooting and burning character. No other clinical signs or symptoms were observed in either case and both patients made an uneventful recovery without neurological sequelae. We review the existing literature on perineal pain as an adverse effect of intravenous corticosteroid esters and recommend their administration either in diluted form or after induction of general anaesthesia.

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“…Dexamethasone is cheap and administration of a single dose is not associated with significant side effects like adrenocortical suppression, hypoglycemia or wound infection. 5 The present study was conducted to evaluate the effect of Dexamethasone as an agent to prevent PONV in comparison to Ondansetron.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Ondansetron with Dexamethasone in the Prevention of Post Operative Nausea and Vomiting in ENT Surgeries

Sugandha¹

2018

jmscr

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Back ground: Post-operative nausea and vomiting is a common morbidity observed after anesthesia and surgery. It is of significance especially in the context of day care surgery. PONV is the reason for unanticipated hospital admission, resulting in stress and financial burden. In this prospective double blind study, we have compared the effectiveness of Dexamethasone and Ondansetron in the prevention of PONV. Materials and Methods: After obtaining approval of the hospital ethical committee and informed consent, 60 adult patients of either sex, scheduled for elective ENT surgeries under general anaesthesia were included in the study. In this prospective double blind study, Group A received Ondansetron 4mg and Group B received Dexamethasone 8mg just before induction of general anesthesia. The antiemetic efficacy and side effects were analyzed. The results of the study were statistically analyzed using the student t test and chi square test. Results: All episodes of nausea and vomiting in the first 24 hour postoperative period during the interval of 0-6 hrs (early PONV) and 6-12 hours (late PONV) were evaluated by a numeric scoring system of PONV. The entire post operative experience was assessed using an 11 point verbal numeric scoring system (0 = not at all satisfied, 10 = fully satisfied).There is no statistically significant difference between Ondansetron and Dexamethasone in preventing postoperative nausea and vomiting either in the early or late postoperative period. But clinically significant difference was noted between these two groups .ie, when 83.3% had no nausea and vomiting in the Dexamethasone group 93.3% had no nausea and vomiting in Ondansetron group. But in the late postoperative period, Dexamethasone had a better effect, ie, while 86.7% had no vomiting in Ondansetron group, 93.3% were free of vomiting episodes in Dexamethasone group. Patient satisfaction score was also comparable. Conclusion:In the prevention of postoperative nausea and vomiting, Ondansetron is clinically better than Dexamethasone in early postoperative period. Dexamethasone is more effective in late postoperative period. Dexamethasone being cheaper and easily available can be considered in prevention of PONV.

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Dexamethasone Antiemesis and Side-Effects

Cited by 22 publications

References 4 publications

Standardizing postoperative care for pediatric intradural Chiari decompressions to decrease length of stay

Standardizing postoperative care for pediatric intradural Chiari decompressions to decrease length of stay

Excruciating Perineal Pain after Intravenous Dexamethasone

Comparison of Ondansetron with Dexamethasone in the Prevention of Post Operative Nausea and Vomiting in ENT Surgeries

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