The effect of single low-dose dexamethasone on vomiting during awake craniotomy

Abstract

A single low-dose of dexamethasone prevents intraoperative vomiting for awake craniotomy cases. However, as even a small dose of dexamethasone increases the risk for hyperglycemia, antiemetic prophylaxis with dexamethasone should be administered after careful consideration. Monitoring of perioperative blood glucose concentration is also necessary.

Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis

“…Heterogeneity was moderate in the MAC subgroup ( I 2 =56%) and substantial in the SAS subgroup ( I 2 =91%) (Supplementary Digital Content 10, http://links.lww.com/JNA/A244: assessment of heterogeneity and publication bias for nausea). The high incidence of nausea and vomiting in the study by Kamata et al37 related to the study design: half of the participants did not receive prophylactic dexamethasone which had a significant effect on the pooled proportion of nausea and vomiting in the SAS subgroup. The overall proportion of intraoperative nausea and vomiting was 6% (95% CI: 2-11) in a pooled sample size of 862 patients.…”

“…The risk of bias for the other nonrandomized studies was assessed using the Newcastle-Ottawa scale 27. We rated the quality of 4 studies as “good”7,29,30,37 and 12 as “poor.”17,35,36,38–46 The quality of evidence for every outcome measure in the studies comparing SAS with MAC was assessed using the GRADE approach28; full details are available in the Supplementary Material (Supplementary Digital Content 4, http://links.lww.com/JNA/A238: certainty assessment per outcome measures).…”

“…In our analysis, 4% and 8% of patients experienced intraoperative nausea and vomiting during MAC and SAS, respectively; the pooled rate was 6%. A single preoperative dose of dexamethasone may reduce the risk of vomiting as described by Kamata et al, 37 and propofol may also play a role in reducing the rate of nausea and vomiting during SAS because of its antiemetic properties. Although there were no statistically significant differences between MAC and SAS with regard to postoperative nausea and vomiting, dexamethasone was routinely administered to minimize this complication in most studies.…”

“…Four RCTs, 16,18,33,34 4 prospective observational studies, 30,[35][36][37] 5 observational retrospective studies, [38][39][40][41][42] and 5 case series 17,[43][44][45][46] were included in the quantitative analysis (Table 1). Information about the anesthetic techniques used in each study is available in the Supplementary Material (Supplementary Digital Content 3, http://links.lww.com/JNA/A237: anesthetic techniques in the included studies).…”