decadron as antiemetic

blood glucose levels. Especially the person is diabetic to begin with, I would consider it contraindicated. And if the person is undergoing chemotherapy, you would also have to consider immune suppression - unless that is a desired effect according to the treatment regimen.

There are some tried and true antiemetics out there. I'd go to a steriod as a last resort.

Not specifically for diabetics, but we have some surgeons who will use it for retractable nausea after all other anti-emetics given. It works. Given as one time order usually. We'll use a sliding scale to control blood sugar, lets take care of the n/v first

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

It is typically used as an antiemetic with many chemo regimens, unless contraindicated (such as with biologics such as high dose IL2). It is usually combined with a 5HT3 drug such as Kytril, for highly emetigenic chemo such as Cisplatin.

But I really cannot see it used routinely with diabetics as it would exacerbate hyperglycemia.

use it all the time, check the research, it is there.

Decadron is not without problems. If you do a medline search you will find a number of case reports of avascular joint necrosis following its use, particularly in cancer patients. It also causes mood swings and delayed healing, the later of which can be an issue in diabetic patients.

I know it has anti-emetic effects, but there may be other drugs or even better anesthesia techniques that work on high risk patients.

I work with three plastic surgeons. The elder one, who is internationally renown (other plastic surgeons come to him for their facelift) does not want any of his patients to have decadron, unless there is a clear airway edema issue. The other two sugeons don't care, so I occassionally give small dose decadron to their patients when there has been a difficult intubation or a lot of head movement causing the tube to move in the trachea. Also, I routinely do NOT give any anti-emetic and rarely have a patient with PONV. The few that do usually respond well to and slow ambulation and adequate hydration.

I still think "less is best" when it comes to giving medications, but I am probably a lone wolf in that regard. But I have a lot of happy patients and am fortunate to see them post-op for weeks and get the feedback from them.

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the research shows that decadron is a very safe antiemetic, this is the subject of my masters project, there are meta-analyses that have not found any of the typical side effects of steroids such as immune suppresion, or complications of hyerglycemia after one-time antiemetic doses. the minimum effective dose was found to be 5-8 mg given before or immediatly after induction. it has additive effects with 5ht3's and propofol, and no additive effect with droperidol or reglan.