Skip to main content
SpringerLink
Log in

Perioperatives Dexamethason

Perioperative dexamethasone

  • Allgemeinanästhesie
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Dexamethason ist ein synthetisches Steroid, das seit vielen Jahren besonders aufgrund seiner antiinflammatorischen, antiallergischen und immunsuppressiven Eigenschaften in der Klinik eingesetzt wird. Darüber hinaus wird Dexamethason schon seit langer Zeit zu Prophylaxe und Therapie des chemotherapeutikainduzierten Übelkeit und Erbrechens angewandt. Inzwischen hat sich Dexamethason als Standard für die Prophylaxe und Therapie des „postoperative nausea and vomiting“ (PONV) bewährt. In dieser Übersichtsarbeit werden Indikationen und Nebenwirkungen von perioperativ verabreichtem Dexamethason dargestellt.

Abstract

Dexamethasone is a synthetic steroid that has been used for many years in the clinical routine due to its anti-inflammatory, anti-allergic and immunosuppressive properties. Furthermore, dexamethasone has been used for a long time for prophylaxis and treatment of chemotherapy-induced nausea and vomiting. In the meantime dexamethasone has been approved as standard for the prophylaxis and treatment of postoperative nausea and vomiting (PONV). This review article outlines the indications and side effects of the perioperative administration of dexamethasone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Alberti E, Hartmann A, Schutz HJ et al (1978) The effect of large doses of dexamethasone on the cerebrospinal fluid pressure in patients with supratentorial tumors. J Neurol 217:173–181

    CAS  PubMed  Google Scholar 

  2. Anonymous (2018) Dexamethasone. Bethesda (MD): National Library of Medicine. US) 2006:86

    Google Scholar 

  3. Apfel CC, Korttila K, Abdalla M et al (2004) A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 350:2441–2451

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Baeriswyl M, Kirkham KR, Jacot-Guillarmod A et al (2017) Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth 119:183–191

    CAS  PubMed  Google Scholar 

  5. Bani-Hashem N, Hassan-Nasab B, Pour EA et al (2011) Addition of intrathecal Dexamethasone to Bupivacaine for spinal anesthesia in orthopedic surgery. Saudi J Anaesth 5:382–386

    PubMed  PubMed Central  Google Scholar 

  6. Basurto Ona X, Uriona Tuma SM, Martinez Garcia L et al (2013) Drug therapy for preventing post-dural puncture headache. Cochrane Database Syst Rev (2):CD001792. https://doi.org/10.1002/14651858.CD001792.pub3

    Article  PubMed  Google Scholar 

  7. Cata JP, Jones J, Sepesi B et al (2016) Lack of Association Between Dexamethasone and Long-Term Survival After Non-Small Cell Lung Cancer Surgery. J Cardiothorac Vasc Anesth 30:930–935

    CAS  PubMed  Google Scholar 

  8. Chanimov M, Koren-Michowitz M, Cohen ML et al (2006) Tumor lysis syndrome induced by dexamethasone. Anesthesiology 105:633–634

    PubMed  Google Scholar 

  9. Chiu C, Aleshi P, Esserman LJ et al (2018) Improved analgesia and reduced post-operative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) pathway for total mastectomy. BMC Anesthesiol 18:41

    PubMed  PubMed Central  Google Scholar 

  10. Chu CC, Hsing CH, Shieh JP et al (2014) The cellular mechanisms of the antiemetic action of dexamethasone and related glucocorticoids against vomiting. Eur J Pharmacol 722:48–54

    CAS  PubMed  Google Scholar 

  11. Coroneos CJ, Voineskos SH, Cook DJ et al (2016) Perioperative Corticosteroids Reduce Short-Term Edema and Ecchymosis in Rhinoplasty: A Meta-Analysis. Aesthet Surg J 36:136–146

    PubMed  PubMed Central  Google Scholar 

  12. Crandell JT (2004) Perineal pruritus after the administration of iv dexamethasone. Can J Anaesth 51:398

    PubMed  Google Scholar 

  13. Creed TJ, Lee RW, Newcomb PV et al (2009) The effects of cytokines on suppression of lymphocyte proliferation by dexamethasone. J Immunol 183:164–171

    CAS  PubMed  Google Scholar 

  14. De Oliveira GS Jr., Almeida MD, Benzon HT et al (2011) Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 115:575–588

    PubMed  Google Scholar 

  15. De Oliveira GS Jr., Bialek JM, Turan A et al (2015) Perioperative Dexamethasone and the Development of Chronic Postmastectomy Pain: A Single-Center Observational Cohort Study. Reg Anesth Pain Med 40:539–544

    PubMed  Google Scholar 

  16. De Oliveira GS Jr., Castro-Alves LJ, Ahmad S et al (2013) Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg 116:58–74

    PubMed  Google Scholar 

  17. De Oliveira GS Jr., Mccarthy R, Turan A et al (2014) Is dexamethasone associated with recurrence of ovarian cancer? Anesth Analg 118:1213–1218

    PubMed  Google Scholar 

  18. Diakos EA, Gallos ID, El-Shunnar S et al (2011) Dexamethasone reduces pain, vomiting and overall complications following tonsillectomy in adults: a systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol 36:531–542

    CAS  PubMed  Google Scholar 

  19. Edwards P, Arango M, Balica L et al (2005) Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet 365:1957–1959

    PubMed  Google Scholar 

  20. Emelife PI, Eng MR, Menard BL et al (2018) Adjunct medications for peripheral and neuraxial anesthesia. Best Pract Res Clin Anaesthesiol 32:83–99

    PubMed  Google Scholar 

  21. Fan ZR, Ma J, Ma XL et al (2018) The efficacy of dexamethasone on pain and recovery after total hip arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Med (baltimore) 97:e100

    CAS  Google Scholar 

  22. Gallant C, Kenny P (1986) Oral glucocorticoids and their complications. A review. J Am Acad Dermatol 14:161–177

    CAS  PubMed  Google Scholar 

  23. Gan TJ, Diemunsch P, Habib AS et al (2014) Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 118:85–113

    PubMed  Google Scholar 

  24. Hussain N, Van Den Langenbergh T, Sermer C et al (2018) Equivalent analgesic effectiveness between perineural and intravenous dexamethasone as adjuvants for peripheral nerve blockade: a systematic review and meta-analysis. Can J Anaesth 65:194–206

    PubMed  Google Scholar 

  25. Jebaraj B, Khanna P, Baidya DK et al (2016) Efficacy of epidural local anesthetic and dexamethasone in providing postoperative analgesia: A meta-analysis. Saudi J Anaesth 10:322–327

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Joung KW, Kim HR, Kim WJ et al (2018) Preoperative dexamethasone for acute post-thoracotomy analgesia: a randomized, double-blind, placebo-controlled study. BMC Anesthesiol 18:135

    PubMed  PubMed Central  Google Scholar 

  27. Kainulainen S, Lassus P, Suominen AL et al (2018) More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial. J Oral Maxillofac Surg 76(11):2425–2432. https://doi.org/10.1016/j.joms.2018.05.007

    PubMed  Google Scholar 

  28. Kirkham KR, Jacot-Guillarmod A, Albrecht E (2018) Optimal Dose of Perineural Dexamethasone to Prolong Analgesia After Brachial Plexus Blockade: A Systematic Review and Meta-analysis. Anesth Analg 126:270–279

    PubMed  Google Scholar 

  29. Knezevic NN, Anantamongkol U, Candido KD (2015) Perineural dexamethasone added to local anesthesia for brachial plexus block improves pain but delays block onset and motor blockade recovery. Pain Physician 18:1–14

    PubMed  Google Scholar 

  30. Le Coz GM, Anton F, Hanesch U (2014) Glucocorticoid-mediated enhancement of glutamatergic transmission may outweigh anti-inflammatory effects under conditions of neuropathic pain. PLoS ONE 9:e91393

    PubMed  PubMed Central  Google Scholar 

  31. Lewis DA, Smith RE (1983) Steroid-induced psychiatric syndromes. A report of 14 cases and a review of the literature. J Affect Disord 5:319–332

    CAS  PubMed  Google Scholar 

  32. Marchand F, Perretti M, Mcmahon SB (2005) Role of the immune system in chronic pain. Nat Rev Neurosci 6:521–532

    CAS  PubMed  Google Scholar 

  33. Mcsorley ST, Roxburgh CSD, Horgan PG et al (2017) The Impact of Preoperative Dexamethasone on the Magnitude of the Postoperative Systemic Inflammatory Response and Complications Following Surgery for Colorectal Cancer. Ann Surg Oncol 24:2104–2112

    PubMed  PubMed Central  Google Scholar 

  34. Merk BA, Havrilesky LJ, Ehrisman JA et al (2016) Impact of postoperative nausea and vomiting prophylaxis with dexamethasone on the risk of recurrence of endometrial cancer. Curr Med Res Opin 32:453–458

    CAS  PubMed  Google Scholar 

  35. Meyer G, Badenhoop K (2018) Addisonian Crisis—Risk Assessment and Appropriate Treatment. Dtsch med Wochenschr 143:392–396

    PubMed  Google Scholar 

  36. Moeen SM, Moeen AM (2017) Intrathecal dexamethasone vs. meperidine for prevention of shivering during transurethral prostatectomy: a randomized controlled trial. Acta Anaesthesiol Scand 61:749–757

    CAS  PubMed  Google Scholar 

  37. Offodile AC 2nd, Gu C, Boukovalas S et al (2018) Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat 173(1):65–77. https://doi.org/10.1007/s10549-018-4991-8

    PubMed  Google Scholar 

  38. Ozdel O, Kara CO, Kara IG et al (2006) Does corticosteroid usage in rhinoplasty cause mood changes? Adv Ther 23:809–816

    CAS  PubMed  Google Scholar 

  39. Pehora C, Pearson AM, Kaushal A et al (2017) Dexamethasone as an adjuvant to peripheral nerve block. Cochrane Database Syst Rev 11:CD11770

    PubMed  Google Scholar 

  40. Plante J, Turgeon AF, Zarychanski R et al (2012) Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: systematic review and meta-analysis of randomised controlled trials. BMJ 345:e5389

    PubMed  PubMed Central  Google Scholar 

  41. Polderman JA, Farhang-Razi V, Van Dieren S et al (2018) Adverse side effects of dexamethasone in surgical patients. Cochrane Database Syst Rev 8:CD11940

    PubMed  Google Scholar 

  42. Purushothaman AM, Pujari VS, Kadirehally NB et al (2018) A prospective randomized study on the impact of low-dose dexamethasone on perioperative blood glucose concentrations in diabetics and nondiabetics. Saudi J Anaesth 12:198–203

    PubMed  PubMed Central  Google Scholar 

  43. Roth P, Happold C, Weller M (2015) Corticosteroid use in neuro-oncology: an update. Neurooncol Pract 2:6–12

    PubMed  Google Scholar 

  44. Rusch D, Eberhart LH, Wallenborn J et al (2010) Nausea and vomiting after surgery under general anesthesia: an evidence-based review concerning risk assessment, prevention, and treatment. Dtsch Arztebl Int 107:733–741

    PubMed  PubMed Central  Google Scholar 

  45. Sandini M, Ruscic KJ, Ferrone CR et al (2018) Intraoperative Dexamethasone Decreases Infectious Complications After Pancreaticoduodenectomy and is Associated with Long-Term Survival in Pancreatic Cancer. Ann Surg Oncol 25:4020–4026

    PubMed  Google Scholar 

  46. Sapolsky RM, Romero LM, Munck AU (2000) How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev 21:55–89

    CAS  Google Scholar 

  47. Sarin R, Murthy V (2003) Medical decompressive therapy for primary and metastatic intracranial tumours. Lancet Neurol 2:357–365

    CAS  PubMed  Google Scholar 

  48. Vayne-Bossert P, Haywood A, Good P et al (2017) Corticosteroids for adult patients with advanced cancer who have nausea and vomiting (not related to chemotherapy, radiotherapy, or surgery). Cochrane Database Syst Rev 7:CD12002

    PubMed  Google Scholar 

  49. Waldron NH, Jones CA, Gan TJ et al (2013) Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 110:191–200

    CAS  PubMed  Google Scholar 

  50. Wang JJ, Ho ST, Lee SC et al (2000) The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study. Anesth Analg 91:1404–1407

    CAS  PubMed  Google Scholar 

  51. Wang LZ, Hu XX, Liu X et al (2011) Influence of epidural dexamethasone on maternal temperature and serum cytokine concentration after labor epidural analgesia. Int J Gynaecol Obstet 113:40–43

    CAS  PubMed  Google Scholar 

  52. Wang S, Lim G, Mao J et al (2007) Central glucocorticoid receptors regulate the upregulation of spinal cannabinoid‑1 receptors after peripheral nerve injury in rats. Pain 131:96–105

    CAS  PubMed  Google Scholar 

  53. Watkins TW, Dupre S, Coucher JR (2015) Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections. J Med Imaging Radiat Oncol 59:571–577

    PubMed  Google Scholar 

  54. Xu D, Chen M, Pan XL et al (2011) Dexamethasone induces fetal developmental toxicity through affecting the placental glucocorticoid barrier and depressing fetal adrenal function. Environ Toxicol Pharmacol 32:356–363

    PubMed  Google Scholar 

  55. Yiu Y, Mahida JB, Cooper JN et al (2017) The effect of perioperative dexamethasone dosing on post-tonsillectomy hemorrhage risk. Int J Pediatr Otorhinolaryngol 98:19–24

    PubMed  Google Scholar 

  56. Yu HC, Luo YX, Peng H et al (2015) Avoiding perioperative dexamethasone may improve the outcome of patients with rectal cancer. Eur J Surg Oncol 41:667–673

    CAS  PubMed  Google Scholar 

  57. Yu Q, Gao L, Gu MH et al (2013) Antiemetic effects of combined methylprednisolone and tropisetron in mastectomy. Minerva Anestesiol 79:130–136

    CAS  PubMed  Google Scholar 

  58. Zhu A, Benzon HA, Anderson TA (2017) Evidence for the Efficacy of Systemic Opioid-Sparing Analgesics in Pediatric Surgical Populations: A Systematic Review. Anesth Analg 125:1569–1587

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93953, Regensburg, Deutschland

    B. Sinner MBA, DEAA

Authors
  1. B. Sinner MBA, DEAA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Sinner MBA, DEAA.

Ethics declarations

Interessenkonflikt

B. Sinner gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sinner, B. Perioperatives Dexamethason. Anaesthesist 68, 676–682 (2019). https://doi.org/10.1007/s00101-019-00672-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-019-00672-x

Schlüsselwörter

Keywords

Search

Navigation