Decadron Question

Dexamethasone for N/V falls under that great catch all of pharm books - "Exact mechanism of action not known." Several mechanisms have been proposed. It is believed that it acts as an prostaglandin antagonist, as well as causing some direct action on the CNS. Regardless of the actual action, a number of studies have been undertaken which have demonstrated prophylaxis for PONV. I've listed a couple references below to get you started.

Dexamethasone is an appealing medication because in the doses and frequency used for PONV, there are minimal documented side effects.

http://www.anesthesia-analgesia.org/content/95/1/229.full

Log In Problems

The antiemetic properties of Decadron are not really well understood. However, research has shown that Decadron may antagonize prostaglandin synthesis and/or release endorphins improving mood, sense of well-being and stimulation of appetite; these factors may play a role in the antiemetic effect of decadron.

I was pimped for this same info as a student and that was the best I could find.

If you go to Pubmed and type in "glucocorticoids and nausea" into the search bar quite a few options come up. http://www.ncbi.nlm.nih.gov/sites/pubmed

Hello. I have a question regarding Decadron. The facility I will be doing clinicals at uses Decadron to prevent PONV. I have always known Decadron to be a great anti-inflammatory drug but never knew it to be utilized for N/V. Can anyone enlighten me as far as the mechanism of how it works to prevent N/V? I can't seem to locate any reliable source that will explain it. Thank you in advance!

Thank you all so much for this information and for taking the time to respond! It was very helpful.

I am going against the trend here, but I rarely, if ever use decadron. The side effects include the patients being hype and feeling great for three days, then they had a low until the adrenal secretions return to normal. In my practice, I see the patients post-op for about four days and I am convinced that the risks outweigh the benefits. I know I am in the minority, but my professional ethics require that I make sure every patient has the best anesthesia experience possible.

BTW, I practice in a facility where the head surgeon had international visitors who want to learn his techniques. He also does not believe in giving steroids and many of his proteges have stopped using it also. They are not convinced that it does not prevent post-op inflammation.

I can think of a side effect.....give it fast and see if the patient can resist the urge to scratch the burning itching you just caused in their crotch.

My personal experience with decadron is worth discussion. I had a minidiscectomy and the neurosurgeon ordered decadron 20 mg. I was so jazzed the next day (partially due to no more pain) that I was cleaning the house, washing the car and starting to tackle reorganizing the garage. Then two days later (post-op day 3), I got very depressed, to the point that I couldn't stop crying and had to have a friend come and sit with me so I didn't do anything I would regret later.

A year or so later, I had a big and long plastic surgery procedure, with NO decadron given. No mood swings, no crazy idea of cleaning and felt emotionally very normal. No PONV with either procedure. Maybe the first response would not have been so dramatic if a lower dose was given, but I would rather do without.

Studies that I reviewed when I was a SRNA demonstrated that Decadron was more efficacious when given with zofran. However, even when given with zofran, decadron was only found to be effective in 30% of the cases. Just some food for thought.