Dexamethasone for postoperative nausea and vomiting
Effect on glucose levels in patients with diabetes
A systematic review with meta-analysis aimed to assess the impact of administering intravenous dexamethasone during surgery to prevent postoperative nausea and vomiting on the highest blood glucose levels in the first 24 hours after elective surgery for patients with diabetes.
Postoperative nausea and vomiting is a significant concern affecting about one-third of surgical patients. When surveyed preoperatively, patients express greater fear of postoperative nausea and vomiting than other complications such as pain. Postoperative nausea and vomiting is linked to increased healthcare costs, longer post-anaesthetic care unit stays, extended hospital lengths of stay, and unexpected admissions for outpatient procedures.
Various factors contribute to postoperative nausea and vomiting, including patient characteristics, surgery type, and anaesthetic technique. Risk factors include female sex, history of postoperative nausea and vomiting or motion sickness, non-smoking status, postoperative opioid use, and certain types of surgeries. Consensus guidelines recommend prophylaxis for all patients, with the intensity based on the number of risk factors.
Managing postoperative nausea and vomiting requires a combination of drugs to balance efficacy and minimise side effects. Ondansetron is traditionally the go-to agent, and dexamethasone is often added for its synergy. Dexamethasone, given intravenously at doses of 4-10 mg, provides benefits like analgesia, anti-inflammatory effects, and improved recovery without sedative effects.
Despite its benefits, some providers are cautious about using dexamethasone in diabetic patients due to potential postoperative hyperglycaemia. This review shows that intravenous dexamethasone (4-10 mg) causes a modest increase in blood glucose levels within 24 hours after surgery in diabetic patients compared to controls. The clinical significance of this small, transient increase is uncertain due to limited data on complication rates and other endpoints. There is no clear dose-response relationship between dexamethasone dose and blood glucose levels.
Intraoperative dexamethasone in diabetic patients, as part of postoperative nausea and vomiting prophylaxis, may offer additional benefits such as improved pain control, reduced opioid consumption, superior recovery, shorter hospital stays, and anti-inflammatory effects. While considering 4-10 mg of dexamethasone may be reasonable, the evidence about its impact on maximum blood glucose levels is not strong enough to make definitive recommendations.
The systematic review with meta-analysis is available in the November 2023 issue of JBI Evidence Synthesis.
Effect of dexamethasone administration for postoperative nausea and vomiting prophylaxis on glucose levels in adults with diabetes undergoing elective surgery: a systematic review with meta-analysis
Dimmen, Andrew; Timko, Sara; Greenwood, Jennifer; McShane, Franklin; Ulinski, Jessica
JBI Evidence Synthesis 21(11):p 2156-2187, November 2023. | DOI: 10.11124/JBIES-22-00300