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Dexamethasone prevents postoperative nausea and vomiting: Benefit versus risk

Dexamethasone prevents postoperative nausea and vomiting: Benefit versus risk
Postoperative nausea and vomiting (PONV) is a common annoying experience after surgery. The overall
incidence of PONV in adults is 20e30%; the incidence rate in patients of high-risk groups can be as high
as 70e80%. Children are not exempted from attacking either; the incidence rate in children above the age
of 3 is more than 40%. The incidence slowly drops after puberty, sharing the same rate with adults.
Dexamethasone can be effective in preventing PONV in adults and children. Compared with other
preventive medications, dexamethasone has equal or even better efficacy in reducing the incidence of
PONV and has the advantages of low cost and longer effectiveness as well. Although the action mechanism
of dexamethasone is hitherto not fully understood, animal studies have confirmed that the
vomiting center in the brain stem plays a central role. A combination of dexamethasone with other
antiemetics is more effective than any single drug alone. Additionally, the use of dexamethasone to
prevent nausea and vomiting triggered by intravenous or epidural morphine for pain control can also
offer a good therapeutic effect. To date, clinically, dexamethasone as a preventative drug against PONV
has not caused fatal outcome; therefore, it is generally considered to be an effective and safe antiemetic.
Nevertheless, its use in this regard may lead to adverse effects, principally postoperative hyperglycemia
and infection.

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