Dexamethasone for intracranial neurosurgery and anaesthesia

Hockey, Brad; Leslie, Kate; Di, Williams

doi:10.1016/j.jocn.2009.03.007

Cited by 37 publications

(25 citation statements)

References 43 publications

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“…However, dexamethasone is associated with a large number of potentially serious side effects, the severity of which depends on the dose and duration of steroid treatment [50]. Adverse side effects include immunosuppression, hypertension, fluid retention and mood disturbances [51]. Emend is currently clinically available as an anti-emetic for chemotherapy-induced nausea, and is associated with minimal side effects.…”

Section: Discussionmentioning

confidence: 99%

Treatment with the NK1 Antagonist Emend Reduces Blood Brain Barrier Dysfunction and Edema Formation in an Experimental Model of Brain Tumors

et al. 2014

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The neuropeptide substance P (SP) has been implicated in the disruption of the blood-brain barrier (BBB) and development of cerebral edema in acute brain injury. Cerebral edema accumulates rapidly around brain tumors and has been linked to several tumor-associated deficits. Currently, the standard treatment for peritumoral edema is the corticosteroid dexamethasone, prolonged use of which is associated with a number of deleterious side effects. As SP is reported to increase in many cancer types, this study examined whether SP plays a role in the genesis of brain peritumoral edema. A-375 human melanoma cells were injected into the right striatum of male Balb/c nude mice to induce brain tumor growth, with culture medium injected in animals serving as controls. At 2, 3 or 4 weeks following tumor cell inoculation, non-treated animals were perfusion fixed for immunohistochemical detection of Albumin, SP and NK1 receptor. A further subgroup of animals was treated with a daily injection of the NK1 antagonist Emend (3 mg/kg), dexamethasone (8 mg/kg) or saline vehicle at 3 weeks post-inoculation. Animals were sacrificed a week later to determine BBB permeability using Evan's Blue and brain water content. Non-treated animals demonstrated a significant increase in albumin, SP and NK1 receptor immunoreactivity in the peritumoral area as well as increased perivascular staining in the surrounding brain tissue. Brain water content and BBB permeability was significantly increased in tumor-inoculated animals when compared to controls (p<0.05). Treatment with Emend and dexamethasone reduced BBB permeability and brain water content when compared to vehicle-treated tumor-inoculated mice. The increase in peritumoral staining for both SP and the NK1 receptor, coupled with the reduction in brain water content and BBB permeability seen following treatment with the NK1 antagonist Emend, suggests that SP plays a role in the genesis of peritumoral edema, and thus warrants further investigation as a potential anti-edematous treatment.

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Section: Discussionmentioning

confidence: 99%

Treatment with the NK1 Antagonist Emend Reduces Blood Brain Barrier Dysfunction and Edema Formation in an Experimental Model of Brain Tumors

et al. 2014

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“…[1] Dexamethasone seems to be the most suitable because it has the highest anti-inflammatory activity, no mineralocorticoid activity and a longest available half-life of 36 to 54 h.[2] Dexamethasone has also been in use in the peri-operative period for post-operative nausea and vomiting[34] pain management[567] and in neurosurgery. [8] Even though, efficacious for preventing and minimizing edema in oral and maxillofacial surgeries, there have been reports attributing post-operative psychosis to peri-operative dexamethasone [Table 1]. [910] In fact in one of the reports a single dose has been implicated for the development of post-operative psychosis.…”

Section: Discussionmentioning

confidence: 99%

Peri-operative dexamethasone therapy and post-operative psychosis in patients undergoing major oral and maxillofacial surgery

Koteswara

Patnaik

2014

J Anaesthesiol Clin Pharmacol

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A broad array of behavioral symptoms, including psychosis, can transpire post-operatively following a variety of surgeries. It is difficult to diagnose the exact cause of post-operative psychosis. We report three cases, which developed psychosis post-operatively after undergoing major oral and maxillofacial surgeries. All the three patients were administered dexamethasone peri-operatively. Dexamethasone is used to prevent or reduce post-operative edema. The exact dose of dexamethasone, which can cause psychosis, is unknown. It is important to raise awareness about this potential complication so that measures for management can be put in place in anticipation of such an event.

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“…Dexamethasone will reduce tumor cerebral edema and this often leads to substantial symptomatic relief [36]. However, its use is associated with an increase in blood glucose levels [19, 20]. The administration of premedication for sedation can be risking in this group of patients.…”

Section: Supratentorial Intracranial Tumorsmentioning

confidence: 99%

“…Patients on antiepileptic medications are known to have adverse effects from these medications as well as intraoperative pharmacokinetic interactions. Patients who have been placed on preoperative dexamethasone may present with elevated blood glucose levels which require careful monitoring [19, 20]. Patients with cerebral insufficiency may be on antiplatelet agents or anticoagulants for treatment of acute stroke, or secondary prevention of strokes from other disease as with patients with cardiac disease including coronary artery stents, prostatic heart valve, and intracardiac thrombus.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Assessment of Adult Patients for Intracranial Surgery

Sivanaser

Manninen

2010

Anesthesiology Research and Practice

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The preoperative assessment of the patient for neurosurgical and endovascular procedures involves the understanding of the neurological disease and its systemic presentation, and the requirements of the procedure. There is a wide spectrum of different neurosurgical disorders and procedures. This article provides an overview of the preoperative evaluation of these patients with respect to general principles of neuroanesthesia, and considerations for specific intracranial and vascular neurosurgical and interventional neuroradiological procedures.

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Dexamethasone for intracranial neurosurgery and anaesthesia

Cited by 37 publications

References 43 publications

Treatment with the NK1 Antagonist Emend Reduces Blood Brain Barrier Dysfunction and Edema Formation in an Experimental Model of Brain Tumors

Treatment with the NK1 Antagonist Emend Reduces Blood Brain Barrier Dysfunction and Edema Formation in an Experimental Model of Brain Tumors

Peri-operative dexamethasone therapy and post-operative psychosis in patients undergoing major oral and maxillofacial surgery

Preoperative Assessment of Adult Patients for Intracranial Surgery

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