Dexamethasone

What is Dexamethasone?

  • Dexamethasone is a glucocorticoid used in the perioperative period for Post-operative Nausea and VomitingPost-operative Nausea and Vomiting
    General Principles

    Many patients undergoing anesthesia will experience post-operative nausea and vomiting
    Anti-emetic medications are given routinely during anesthesia.
    Combining agents of d...     and airway swelling.

Mechanism of Action 12

  • Dexamethasone binds to intracellular glucocorticoid receptors inhibiting inflammatory mediators.
  • Inhibits prostaglandin synthesis and causes antiemetic effect.

Indications 12

  • Antiemetic: Prevention and treatment of Post-operative Nausea and VomitingPost-operative Nausea and Vomiting
    General Principles

    Many patients undergoing anesthesia will experience post-operative nausea and vomiting
    Anti-emetic medications are given routinely during anesthesia.
    Combining agents of d...     (PONV).
  • Anti-inflammatory: Often used in ENT and airway surgery to reduce the risk of swelling.
  • Cerebral Edema: Reduction of intracranial pressure, generally reserved for brain tumors

Dosage 2

  • PONV: 0.1 mg/kg IV up to 4-6 mg 2
  • Inflammatory: Dose depends on clinical scenario, but 0.1-0.2 mg/kg up to ~10mg is common.

Pharmacokinetics 1

  • Onset of Action: 2-4 hours
  • Half-life: 36-54 hours.
  • Metabolism: Hepatic
  • Excretion: Metabolites are primarily excreted in the urine.

Complications 2

  • Hyperglycemia
  • Adrenal Suppression: Generally risk increases with prolonged use.
  • Perineal Pain: Rapid injection in awake patients often results in perineal pain.

References

  1. Birdi T, Sullivan P. Ottawa anesthesia primer. Toronto, Ontario: Echo Book Publishing; 2012. ↩ ↩2 ↩3

  2. Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020. ↩ ↩2 ↩3 ↩4 ↩5