Benefits and Risks of Dexamethasone in Noncardiac Surgery

D examethasone is a commonly used drug in anesthe- sia and surgery.The purported beneficial effects are diverse, especially for the prophylaxis and treatment of postoperative nausea and vomiting, but the optimal dose and the clinical implications of potential side effects require an updated summary of all available evidence.This article reviews major trials and other studies of perioperative dexamethasone in adult noncardiac surgery, focusing on patient selection, optimal dose, and safety.We briefly consider its mode(s) of action and central role in the management of postoperative nausea and vomiting before providing updates on the benefits of dexamethasone for postoperative pain, quality of recovery, fatigue, sleep disturbance and mood, major complications and death, surgical site infection, hyperglycemia and diabetes control, and perioperative neurocognitive disorders, and conclude with a consideration of the optimal dexamethasone dose.We will not consider its use in pediatrics, cardiac surgery, or as a perineural adjuvant in peripheral nerve blocks.In 2020, Weibel et al. published their results of an extensive systematic review and network meta-analysis comparing the clinical effect and safety of antiemetic drugs in adults undergoing any type of surgery under general anesthesia. 1 The authors concluded that effectiveness for postoperative nausea and vomiting has been convincingly demonstrated but that additional studies were needed to properly investigate the potential adverse effects of dexamethasone, including in patients with diabetes. 1Such information has now become available.