decadron as antiemetic

Blee O'Myacin, BSN, RN · Apr 14, 2006

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.

Hi,
wondering if anyone has any evidence to support using decadron as an antiemetic in diabetics?
Thanks.

nursenatalie, ADN, RN · Apr 14, 2006

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

versatile_kat · Apr 14, 2006

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10625002&dopt=Abstract

caroladybelle, BSN, RN · Apr 15, 2006

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.

skrunchy · Apr 15, 2006

Thanks to all who responded, it came up in class the other day and I was wondering what info was out there.

CougRN · Apr 15, 2006

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

yoga crna · Apr 15, 2006

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.

JJRN · Apr 15, 2006

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catcolalex · Apr 15, 2006

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.

jwk · Apr 15, 2006

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.

I think the late complications are more of a concern (AVN, etc.)

It's not used as the sole antiemetic in our practice. When surgeon's request it (the only time we give it) it's usually in combination with Zofran and benadryl and requests for no N20. I think it's gross overkill. I get better overall results personally with doing my usual des-N20-fentanyl anesthetic with zofran, and with generous hydration before going to the PACU. I think pain and relative hypovolemia are responsible for a lot more nausea and vomiting than most people think.

geekgolightly, BSN, RN · Apr 18, 2006

jwk

I would like to send a PM to you but your PM storage space is full. Would you mind deleting a message? Sorry to be so forward. It's about UMKC's AA program start up.

Thanks!

Kathy