Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Nov 23;11(11):CD011940.
doi: 10.1002/14651858.CD011940.pub3.

Adverse side effects of dexamethasone in surgical patients

Jorinde Aw Polderman  1 , Violet Farhang-Razi, Susan Van Dieren, Peter Kranke, J Hans DeVries, Markus W Hollmann, Benedikt Preckel, Jeroen Hermanides
Affiliations
Meta-Analysis

Adverse side effects of dexamethasone in surgical patients

Jorinde Aw Polderman et al. Cochrane Database Syst Rev. .

Abstract

Background: In the perioperative period, dexamethasone is widely and effectively used for prophylaxis of postoperative nausea and vomiting (PONV), for pain management, and to facilitate early discharge after ambulatory surgery.Long-term treatment with steroids has many side effects, such as adrenal insufficiency, increased infection risk, hyperglycaemia, high blood pressure, osteoporosis, and development of diabetes mellitus. However, whether a single steroid load during surgery has negative effects during the postoperative period has not yet been studied.

Objectives: To assess the effects of a steroid load of dexamethasone on postoperative systemic or wound infection, delayed wound healing, and blood glucose change in adult surgical patients (with planned subgroup analysis of patients with and without diabetes).

Search methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, and the Web of Science for relevant articles on 29 January 2018. We searched without language or date restriction two clinical trial registries to identify ongoing studies, and we handsearched the reference lists of relevant publications to identify all eligible trials.

Selection criteria: We searched for randomized controlled trials comparing an incidental steroid load of dexamethasone versus a control intervention for adult patients undergoing surgery. We required that studies include a follow-up of 30 days for proper assessment of the number of postoperative infections, delayed wound healing, and the glycaemic response.

Data collection and analysis: Two review authors independently screened studies for eligibility, extracted data from relevant studies, and assessed all included studies for bias. We resolved differences by discussion and pooled included studies in a meta-analysis. We calculated Peto odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes. Our primary outcomes were postoperative systemic or wound infection, delayed wound healing, and glycaemic response within 24 hours. We created a funnel plot for the primary outcome postoperative (wound or systemic) infection. We used GRADE to assess the quality of evidence for each outcome.

Main results: We included in the meta-analysis 37 studies that included adults undergoing a large variety of surgical procedures (i.e. abdominal surgery, cardiac surgery, neurosurgery, and orthopaedic surgery). We excluded one previously included study, as this study was recently retracted. Age range of participants was 18 to 80 years. There is probably little or no difference in the risk of postoperative (wound or systemic) infection with dexamethasone compared with no treatment, placebo, or active control (ramosetron, ondansetron, or tropisetron) (Peto OR 1.01, 95% confidence interval (CI) 0.80 to 1.27; 4603 participants, 26 studies; I² = 32%; moderate-quality evidence). The effects of dexamethasone on delayed wound healing are unclear because the wide confidence interval includes both meaningful benefit and harm (Peto OR 0.99, 95% CI 0.28 to 3.43; 1072 participants, eight studies; I² = 0%; low-quality evidence). Dexamethasone may produce a mild increase in glucose levels among participants without diabetes during the first 12 hours after surgery (MD 13 mg/dL, 95% CI 6 to 21; 10 studies; 595 participants; I² = 50%; low-quality evidence). We identified two studies reporting on glycaemic response after dexamethasone in participants with diabetes within 24 hours after surgery (MD 32 mg/dL, 95% CI 15 to 49; 74 participants; I² = 0%; very low-quality evidence).

Authors' conclusions: A single dose of dexamethasone probably does not increase the risk for postoperative infection. It is uncertain whether dexamethasone has an effect on delayed wound healing in the general surgical population owing to imprecision in trial results. Participants with increased risk for delayed wound healing (e.g. participants with diabetes, those taking immunosuppressive drugs) were not included in the randomized studies reporting on delayed wound healing included in this meta-analysis; therefore our findings should be extrapolated to the clinical setting with caution. Furthermore, one has to keep in mind that dexamethasone induces a mild increase in glucose. For patients with diabetes, very limited evidence suggests a more pronounced increase in glucose. Whether this influences wound healing in a clinically relevant way remains to be established. Once assessed, the two studies awaiting classification and three that are ongoing may alter the conclusions of this review.

PubMed Disclaimer

Conflict of interest statement

Jorinde AW Polderman: none declared.

Violet Farhang‐Razi: none declared.

Susan Van Dieren: none declared.

Peter Kranke.

  1. Consultancy (money paid to author): MSD; Fresenius Kabi.

  2. Grants/grants pending (money to institution): Fresenius Kabi; Premier Research (Acacia Ltd).

  3. Payment for lectures including service on speakers bureaus (money paid to author): Fresenius Kabi; MSD.

None of the companies listed for Dr Kranke's COI have any relation to the current work.

J Hans DeVries.

  1. Consulting fee or honorarium: Johnson & Johnson.

  2. Board membership (money to institution): Novo Nordisk; Johnson & Johnson; Roche Diagnostics.

  3. Consultancy (money to institution): Sanofi.

  4. Grants/grants pending (money to institution): Dexcom; Senseonics; Novartis; Novo Nordisk; ECHO Therapeutics.

  5. Payment for lectures including service on speakers bureaus (money to institution): Medtronic; Dexcom; Eli Lilly; Roche.

  6. Diagnostics: Novo Nordisk; Sanofi; MSD.

  7. Dr DeVries's institution received research support, fees for advice, and speaker's fees from Abbott Diabetes Care; Dexcom Inc; Eli Lilly; Medtronic; Novo Nordisk; Novartis; Roche Diagnostics; and Sanofi.

None of these bear any relation to the current work. None of the companies listed market products/drugs in this area.

Markus W Hollmann.

  1. Board membership: IARS; Anesthesia & Analgesia.

  2. Consultancy (money to institution): Pfizer; Eurocept; B Braun; ECHO; Fresenius; Merck.

  3. Grants/grants pending (money to institution): ZonMw.

  4. Payment for lectures including service on speakers bureaus (money to institution): Eurocept/Octapharm; Merck; B Braun; Pfizer.

  5. Payment for development of educational presentations (money to institution): Merck.

None of the above declared relationships have influenced this work in that all activities are completely unrelated to the work presented in this review. None of the companies listed market products/drugs in this area.

Benedikt Preckel.

  1. Grants/grants pending (money to institution): European Foundation for the Study of Diabetes; Society of Cardiovascular Anesthesia; Dutch Society of Anesthesia; ZonMw (Dutch Organization for Health Care).

  2. Payment for lectures including service on speakers bureaus (money to institution): Philips Germany; Abbott Netherlands.

None of the companies listed market products/drugs in this area.

Jeroen Hermanides.

  1. Research grants: European Foundation for the Study of Diabetes, European Society for Anaesthesiology. Pending funding (to institution) for investigator‐initiated trial from NovoNordisk. Speaker fee: Eli Lilly.

None of the above declared relationships have influenced this work in that all activities are completely unrelated to the work presented in this review. None of the companies listed market products/drugs in this area.

Figures

1
1
Flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 dexamethasone versus control, outcome: 1.1 Postoperative systemic or wound infection.
1.1
1.1. Analysis
Comparison 1 Dexamethasone versus control, Outcome 1 Postoperative systemic or wound infection.
1.2
1.2. Analysis
Comparison 1 Dexamethasone versus control, Outcome 2 Subgroup analysis for postoperative systemic or wound infection: single vs multiple doses of dexamethasone.
1.3
1.3. Analysis
Comparison 1 Dexamethasone versus control, Outcome 3 Delayed wound healing.
1.4
1.4. Analysis
Comparison 1 Dexamethasone versus control, Outcome 4 Glycaemic response.
1.5
1.5. Analysis
Comparison 1 Dexamethasone versus control, Outcome 5 Re‐admission or unplanned hospital admission.
1.6
1.6. Analysis
Comparison 1 Dexamethasone versus control, Outcome 6 Mortality.
1.7
1.7. Analysis
Comparison 1 Dexamethasone versus control, Outcome 7 Sensitivity analysis excluding high risk of bias studies from Analysis 1.1.
1.8
1.8. Analysis
Comparison 1 Dexamethasone versus control, Outcome 8 Sensitivity analysis excluding skewed glucose data.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Abdelmalak 2013a {published data only}
    1. Abdelmalak BB, Bonilla A, Mascha EJ, Maheshwari A, Tang WH, You J, et al. Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial. British Journal of Anaesthesia 2013;111(2):209‐21. [PUBMED: 23539236] - PubMed
Abdelmalak 2013b {published data only}
    1. Abdelmalak BB, Bonilla AM, Yang D, Chowdary HT, Gottlieb A, Lyden SP, et al. The hyperglycemic response to major noncardiac surgery and the added effect of steroid administration in patients with and without diabetes. Anesthesia and Analgesia 2013;116(5):1116‐22. [PUBMED: 23558840] - PubMed
Abukawa 2017 {published data only}
    1. Abukawa H, Ogawa T, Kono M, Koizumi T, Kawase‐Koga Y, Chikazu D. Intravenous dexamethasone administration before orthognathic surgery reduces the postoperative edema of the masseter muscle: a randomized controlled trial. Journal of Oral Maxillofacial Surgery 2017;75(6):1257‐62. [PUBMED: 28157491 ] - PubMed
Backes 2013 {published data only}
    1. Backes JR, Bentley JC, Politi JR, Chambers BT. Dexamethasone reduces length of hospitalization and improves postoperative pain and nausea after total joint arthroplasty: a prospective, randomized controlled trial. Journal of Arthroplasty 2013;28(8 Suppl):11‐7. [PUBMED: 23937923 ] - PubMed
Bisgaard 2003 {published data only}
    1. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double‐blind placebo‐controlled trial. Annals of Surgery 2003;238(5):651‐60. [PUBMED: 14578725] - PMC - PubMed
Bjornholdt 2014 {published data only}
    1. Bjornholdt KT, Monsted PN, Soballe K, Nikolajsen L. Dexamethasone for pain after outpatient shoulder surgery: a randomised, double‐blind, placebo‐controlled trial. Acta Anaesthesiologica Scandinavica 2014;58(6):751‐8. [PUBMED: 24825530] - PubMed
Choi 2013 {published data only}
    1. Choi YS, Shim JK, Song JW, Kim JC, Yoo YC, Kwak YL. Combination of pregabalin and dexamethasone for postoperative pain and functional outcome in patients undergoing lumbar spinal surgery: a randomized placebo‐controlled trial. Clinical Journal of Pain 2013;29(1):9‐14. [PUBMED: 22751028] - PubMed
Corocan 2017 {published data only}
    1. Corocan T, Paech M, Law D, Muchatuta NA, French M, Ho KM. Intraoperative dexamethasone alters immune cell populations in patients undergoing elective laparoscopic gynaecological surgery. British Journal of Anaesthesia 2017;119(2):221‐30. [PUBMED: 28854534] - PubMed
Cortes‐Flores 2018 {published data only (unpublished sought but not used)}
    1. Cortés‐Flores AO, Jiménez‐Tornero J, Morgan‐Villela G, Delgado‐Gómez M, Zuloaga‐Fernández Del Valle CJ, García‐Rentería J, et al. Effects of preoperative dexamethasone on postoperative pain, nausea, vomiting and respiratory function in women undergoing conservative breast surgery for cancer: results of a controlled clinical trial. European Journal of Cancer Care 2018;27(1):DOI: 10.1111. [PUBMED: 28474341] - PubMed
Cowie 2010 {published data only}
    1. Cowie BS, Allen KJ, Said SA, Inder WJ. Anti‐emetic doses of dexamethasone suppress cortisol response in laparoscopic cholecystectomy. Anaesthesia and Intensive Care 2010;38(4):667‐70. [PUBMED: 20715729] - PubMed
Doksrod 2012 {published data only}
    1. Doksrod S, Sagen O, Nostdahl T, Raeder J. Dexamethasone does not reduce pain or analgesic consumption after thyroid surgery: a prospective, randomized trial. Acta Anaesthesiologica Scandinavica 2012;56(4):513‐9. [PUBMED: 22924169] - PubMed
DREAMS trial collaborators {published data only}
    1. DREAMS Trial Collaborators and West Midlands Research Collaborative. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial). BMJ 2017;357(1455):10.1136/bmj.j1455. [PUBMED: 28420629] - PMC - PubMed
Feroci 2011 {published data only}
    1. Feroci F, Rettori M, Borrelli A, Lenzi E, Ottaviano A, Scatizzi M. Dexamethasone prophylaxis before thyroidectomy to reduce postoperative nausea, pain, and vocal dysfunction: a randomized clinical controlled trial. Head & Neck 2011;33(6):840‐6. [PUBMED: 20737495] - PubMed
Ionescu 2014 {published data only}
    1. Ionescu DC, Hadade AI, Mocan TA, Margarit SD. The influence of a prophylactic dose of dexamethasone for postoperative nausea and vomiting on plasma interleukin concentrations after laparoscopic cholecystectomy: a randomised trial. European Journal of Anaesthesiology 2014;31(4):204‐11. [PUBMED: 23880908 ] - PubMed
Kalappa 2017 {published data only}
    1. Kalappa S, Sridhar RB, Nagappa S. Comparing the efficacy of caudal with intravenous dexamethasone in the management of pain following lumbosacral spine surgeries: a randomized double blinded controlled study. Anesthesia Essays and Researches 2017;11(2):416‐20. [PUBMED: 28663633] - PMC - PubMed
Karacinar 2009 {published data only}
    1. Karacinar M, Madenoglu H, Aksu R, Bicer C, Dogru K, Boyaci A. The effect of different doses of dexamethasone on blood glucose, serum electrolytes and postoperative nausea‐vomiting in craniotomies [Kraniyotomilerde farkli dozlarda deksametazonun kan glukozu, elektrolitler ve postoperatif bulanti kusma uzerine etkisi LA]. Erciyes Tip Dergisi [Internet] 2009;31(3):218‐25. [EMBASE: 2010030961]
Kawanishi 2014 {published data only}
    1. Kawanishi R, Yamamoto K, Tobetto Y, Nomura K, Kato M, Go R, et al. Perineural but not systemic low‐dose dexamethasone prolongs the duration of interscalene block with ropivacaine: a prospective randomized trial. Local and Regional Anesthesia 2014;7:5‐9. [PUBMED: 24817819] - PMC - PubMed
Kirdak 2008 {published data only}
    1. Kirdak T, Yilmazlar A, Cavun S, Ercan I, Yilmazlar T. Does single, low‐dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double‐blind, randomized clinical trial. American Surgeon 2008;74(2):160‐7. [PUBMED: 18306871] - PubMed
Kleif 2017 {published data only}
    1. Kleif J, Kirkegaard A, Vilandt J, Gogenur I. Randomized clinical trial of preoperative dexamethasone on postoperative nausea and vomiting after laparoscopy for suspected appendicitis. British Journal of Surgery 2017;104(4):384‐92. [PUBMED: 28072446] - PubMed
Koh 2013 {published data only}
    1. Koh IJ, Chang CB, Lee JH, Jeon YT, Kim TK. Preemptive low‐dose dexamethasone reduces postoperative emesis and pain after TKA: a randomized controlled study. Clinical Orthopaedics and Related Research 2013;471(9):3010‐20. [PUBMED: 23645340] - PMC - PubMed
Kurz 2015 {published data only}
    1. Kurz A, Fleischmann E, Sessler DI, Buggy DJ, Apfel C, Akca O, et al. Effects of supplemental oxygen and dexamethasone on surgical site infection: a factorial randomized trial. British Journal of Anaesthesia 2015;115(3):434‐43. [PUBMED: 25900659] - PubMed
Lei 2017 {published data only}
    1. Lei Y, Huang Q, Xu B, Zhang S, Cao G, Pei F. Multiple low‐dose dexamethasone further improves clinical outcomes following total hip arthroplasty. Journal of Arthroplasty 2017;S0883‐5403(17):doi: 10.1016. [PUBMED: 29258763] - PubMed
Murphy 2011a {published data only}
    1. Murphy GS, Sherwani SS, Szokol JW, Avram MJ, Greenberg SB, Patel KM, et al. Small‐dose dexamethasone improves quality of recovery scores after elective cardiac surgery: a randomized, double‐blind, placebo‐controlled study. Journal of Cardiothoracic and Vascular Anesthesia 2011;25(6):950‐60. [PUBMED: 21565530] - PubMed
Murphy 2014 {published data only}
    1. Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Shear T, Vender JS, et al. The effect of single low‐dose dexamethasone on blood glucose concentrations in the perioperative period: a randomized, placebo‐controlled investigation in gynecologic surgical patients. Anesthesia and Analgesia 2014;118(6):1204‐12. [PUBMED: 24299928 ] - PubMed
Nazar 2009 {published data only}
    1. Nazar CE, Lacassie HJ, Lopez RA, Munoz HR. Dexamethasone for postoperative nausea and vomiting prophylaxis: effect on glycaemia in obese patients with impaired glucose tolerance. European Journal of Anaesthesiology 2009;26(4):318‐21. [PUBMED: 19401661] - PubMed
Nazar 2011 {published data only}
    1. Nazar CE, Echevarria GC, Lacassie HJ, Flores RA, Munoz HR. [Effects on blood glucose of prophylactic dexamethasone for postoperative nausea and vomiting in diabetics and non‐diabetics]. Revista Medica de Chile 2011;139(6):755‐61. [PUBMED: 22051756 ] - PubMed
Nielsen 2015 {published data only}
    1. Nielsen RV, Siegel H, Fomsgaard JS, Andersen JDH, Martusevicius R, Mathiesen O, et al. Preoperative dexamethasone reduces acute but not sustained pain after lumbar disk surgery: a randomized, blinded, placebo‐controlled trial. Pain 2015;156(12):2538‐44. [PUBMED: 26270586 ] - PubMed
Rafiq 2014 {published data only}
    1. Rafiq S, Steinbruchel DA, Wanscher MJ, Andersen LW, Navne A, Lilleoer NB, et al. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery: a randomized controlled trial. Journal of Cardiothoracic Surgery 2014;9(1):52. [PUBMED: 24650125] - PMC - PubMed
Sanchez‐Rodriguez 2010 {published data only}
    1. Sanchez‐Rodriguez PE, Fuentes‐Orozco C, Gonzalez‐Ojeda A. Effect of dexamethasone on postoperative symptoms in patients undergoing elective laparoscopic cholecystectomy: randomized clinical trial. World Journal of Surgery 2010;34(5):895‐900. [PUBMED: 20151129 ] - PubMed
Schietroma 2010 {published data only}
    1. Schietroma M, Giuliani M, Zoccali G, Carnei F, Bianchi Z, Amiccucci G, et al. How does dexamethasone influence surgical outcome after laparoscopic Nissen fundoplication? A randomized double‐blind placebo‐controlled trial. Updates in Surgery 2010;62(1):47‐54. [PUBMED: 20845101] - PubMed
Tien 2016 {published data only}
    1. Tien M, Gan TJ, Dhakal I, White WD, Olufolabi AJ, Fink R, et al. The effect of anti‐emetic doses of dexamethasone on postoperative blood glucose levels in non‐diabetic and diabetic patients: a prospective randomised controlled study. Anaesthesia 2016;71(9):1037‐43. [PUBMED: 27523051] - PubMed
Wakasugi 2015 {published data only}
    1. Wakasugi M, Tori M, Shimizu J, Kim YK, Noda T, Dono K, et al. Efficacy of preoperative dexamethasone for postoperative nausea and vomiting after laparoscopic cholecystectomy: a large‐scale, multicenter, randomized, double‐blind, placebo‐controlled trial in Japan. Journal of Hepato‐Biliary‐Pancreatic Sciences 2015;22(11):802‐9. [PUBMED: 26288165] - PubMed
Wang 2009 {published data only}
    1. Wang Y, Song XH, Wu LL. Effects of different glucocorticoids on blood glucose during surgery under general anesthesia. Zhonghua Yi Xue Za Zhi 2009;89(27):1913‐5. [PUBMED: 19953915] - PubMed
Worni 2008 {published data only}
    1. Worni M, Schudel HH, Seifert E, Inglin R, Hagemann M, Vorburger SA, et al. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Annals of Surgery 2008;248(6):1060‐6. [PUBMED: 19092351] - PubMed
Zargar‐Shoshtari 2009 {published data only}
    1. Zargar‐Shoshtari K, Sammour T, Kahokehr A, Connolly AB, Hill AG. Randomized clinical trial of the effect of glucocorticoids on peritoneal inflammation and postoperative recovery after colectomy. British Journal of Surgery 2009;96(11):1253‐61. [PUBMED: 19847865 ] - PubMed
Zhang 2016 {published data only}
    1. Zhang HW, Fan YB, Lu J, Wu B, Xu C, Zhou QH. Protective effect of perioperative low‐dose dexamethasone on sore throat after thyroidectomy. Journal of Shanghai Jiaotong University (Medical Science) 2016;36(6):870‐4.
Zhou 2012 {published data only}
    1. Zhou H, Xu H, Zhang J, Wang W, Wang Y, Hu Z. Combination of dexamethasone and tropisetron before thyroidectomy to alleviate postoperative nausea, vomiting, and pain: randomized controlled trial. World Journal of Surgery 2012;36(6):1217‐24. [PUBMED: 22146946 ] - PubMed

References to studies excluded from this review

Abbaszadeh 2012 {published data only}
    1. Abbaszadeh M, Khan ZH, Mehrani F, Jahanmehr H. Perioperative intravenous corticosteroids reduce incidence of atrial fibrillation following cardiac surgery: a randomized study. Revista Brasileira De Cirurgia Cardiovascular 2012;27(1):18‐23. [PUBMED: 22729297] - PubMed
Al‐Shehri 2004 {published data only}
    1. Al‐Shehri AM. Steroid therapy for post‐tonsillectomy symptoms in adults: a randomized, placebo‐controlled study. Annals of Saudi Medicine 2004;24(5):365‐7. [PUBMED: 15573850] - PMC - PubMed
Bianchin 2007 {published data only}
    1. Bianchin A, Luca A, Caminiti A. Postoperative vomiting reduction after laparoscopic cholecystectomy with single dose of dexamethasone. Minerva Anestesiologica 2007;73(6):343‐6. [PUBMED: 17589423] - PubMed
Coloma 2001 {published data only}
    1. Coloma M, Duffy LL, White PF, Kendall Tongier W, Huber PJ. Dexamethasone facilitates discharge after outpatient anorectal surgery. Anesthesia and Analgesia 2001;92(1):85‐8. [PUBMED: 11133606] - PubMed
Halvorsen 2003 {published data only}
    1. Halvorsen P, Raeder J, White PF, Almdahl SM, Nordstrand K, Saatvedt K, et al. The effect of dexamethasone on side effects after coronary revascularization procedures. Anesthesia and Analgesia 2003;96(6):1578‐83, table of contents. [PUBMED: 12760978] - PubMed
Ho 2001 {published data only}
    1. Ho ST, Wang JJ, Tzeng JI, Liu HS, Ger LP, Liaw WJ. Dexamethasone for preventing nausea and vomiting associated with epidural morphine: a dose‐ranging study. Anesthesia and Analgesia 2001;92(3):745‐8. [PUBMED: 11226112] - PubMed
Jung 2013 {published data only}
    1. Jung H, Kim HJ. Dexamethasone contributes to the patient management after ambulatory laryngeal microsurgery by reducing sore throat. European Archives of Oto‐rhino‐laryngology 2013;270(12):3115‐9. [PUBMED: 24057101 ] - PubMed
Kara 1999 {published data only}
    1. Kara CO, Gokalan I. Effects of single‐dose steroid usage on edema, ecchymosis, and intraoperative bleeding in rhinoplasty. Plastic and Reconstructive Surgery 2001;104(7):2213‐8. [PUBMED: 11149790] - PubMed
Lei 2018a {published data only}
    1. Lei YT, Xu B, Xie XW, Xie JW, Huang Q, Pei FX. The efficacy and safety of low‐dose peri‐operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial. International Orthopaedics 2018;42(3):499‐505. [PUBMED: 28647788] - PubMed
Liu 2001 {published data only}
    1. Liu YH, Li MJ, Wang PC, Ho ST, Chang CF, Ho CM, et al. Use of dexamethasone on the prophylaxis of nausea and vomiting after tympanomastoid surgery. Laryngoscope 2001;111(7):1271‐4. [PUBMED: 11568553 ] - PubMed
Nasiri 2013 {published data only}
    1. Nasiri S, Shafag S, Khorgami Z, Sodagari N, Aminian A, Hedayat A. Does corticosteroid have any beneficial effect on voice change after thyroidectomy?. American Surgery 2013;79(12):1258‐62. [PUBMED: 24351352] - PubMed
Pasternak 2004 {published data only}
    1. Pasternak JJ, McGregor DG, Lanier WL. Effect of single‐dose dexamethasone on blood glucose concentration in patients undergoing craniotomy. Journal of Neurosurgical Anesthesiology 2004;16(2):122‐5. [PUBMED: 15021280] - PubMed
Schietroma 2013 {published data only}
    1. Piccirillo JF, Bauchner H. Expression of Concern: Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L, Amicucci G. Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery: a randomized double‐blind placebo‐controlled trial. JAMA Otolaryngology ‐ Head & Neck Surgery 2013; 139(5):471‐8. doi:10.1001/jamaoto.2013.2821. JAMA Otolaryngology – Head & Neck Surgery 2017;143(9):869. [DOI: 10.1001/jamaoto.2017.1641; PUBMED: 28732099] - DOI - PubMed
    1. Piccirillo JF, Bauchner H. Notice of Retraction: Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L, Amicucci G. Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid Surgery: a randomized double‐blind placebo‐controlled trial. JAMA Otolaryngology ‐ Head & Neck Surgery 2013;139(5):471‐8. doi:10.1001/jamaoto.2013.2821. JAMA Otolaryngology – Head & Neck Surgery 2018 2018:Epub ahead of print. [DOI: 10.1001/jamaoto.2018.3018; PUBMED: 30325981] - DOI - PubMed
    1. Schietroma M, Cecilia EM, Carlei F, Sista F, Santis G, Lancione L, et al. Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery: a randomized double‐blind placebo‐controlled trial. JAMA Otolaryngology ‐ Head & Neck Surgery 2013;139(5):471‐8. [PUBMED: 23681030] - PubMed
Sethi 2016 {published data only}
    1. Sethi R, Naqash IA, Bajwa SJ, Dutta V, Ramzan AU, Zahoor SA. Evaluation of hyperglycaemic response to intra‐operative dexamethasone administration in patients undergoing elective intracranial surgery: a randomised, prospective study. Asian Journal of Neurosurgery 2016;11(2):98‐102. [PUBMED: 27057213] - PMC - PubMed
Snall 2014 {published data only}
    1. Snall J, Kormi E, Koivusalo AM, Lindqvist C, Suominen AL, Tornwall J, et al. Effects of perioperatively administered dexamethasone on surgical wound healing in patients undergoing surgery for zygomatic fracture: a prospective study. Oral Surgery Oral Medicine Oral Pathology Oral Radiology 2014;117(6):685‐9. [PUBMED: 24842445] - PubMed
Thangaswamy 2010 {published data only}
    1. Thangaswamy CR, Rewari V, Trikha A, Chandralekha DM. Dexamethasone before total laparoscopic hysterectomy: a randomized controlled dose‐response study. Journal of Anesthesia 2010;24(1):24‐30. [PUBMED: 20052502] - PubMed
Tolver 2012 {published data only}
    1. Tolver MA, Strandfelt P, Bryld EB, Rosenberg J, Bisgaard T. Randomized clinical trial of dexamethasone versus placebo in laparoscopic inguinal hernia repair. British Journal of Surgery 2012;99(10):1374‐80. [PUBMED: 22961516] - PubMed
Wang 2000 {published data only}
    1. Wang JJ, Ho ST, Lee SC, Liu YC, Ho CM. The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose‐ranging study. Anesthesia and Analgesia 2000;91(6):1404‐7. [PUBMED: 11093989] - PubMed
Wang 2001 {published data only}
    1. Wang JJ, Ho ST, Wong CS, Tzeng JI, Liu HS, Ger LP. Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post‐Cesarean analgesia. Canadian Journal of Anaesthesia 2001;48(2):185‐90. [PUBMED: 11220429] - PubMed
Weber 1994 {published data only}
    1. Weber CR, Griffin JM. Evaluation of dexamethasone for reducing postoperative edema and inflammatory response after orthognathic surgery. Journal of Oral and Maxillofacial Surgery 1994;52(1):35‐9. [PUBMED: 8263640] - PubMed
Wu 2007 {published data only}
    1. Wu JI, Lo Y, Chia YY, Liu K, Fong WP, Yang LC, et al. Prevention of postoperative nausea and vomiting after intrathecal morphine for Cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination. International Journal of Obstetric Anesthesia 2007;16(2):122‐7. [PUBMED: 17275282 ] - PubMed

References to studies awaiting assessment

Ko‐Iam 2015 {published data only}
    1. Ko‐Iam W, Sandhu T, Paiboonworachat S, Pongchairerks P, Junrungsee S, Chotirosniramit A, et al. Metoclopramide versus its combination with dexamethasone in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double‐blind randomized controlled trial. Journal of the Medical Association of Thailand 2015;98(3):265‐72. [PUBMED: 25920297] - PubMed
Simogai 2016 {published data only}
    1. Simogai M, Kayo R. Prevention of postoperative nausea and vomiting associated with postoperative fentanyl infusion by dexamethasone and combined diphenhydramine and diprophylline preparation (Travelmin). [Japanese]. Medical Journal of Minami Osaka Hospital 2016;63(1):17‐20.

References to ongoing studies

Kitcharanant 2016 {unpublished data only}
    1. Kitcharanant N. Effects of perioperative intravenous dexamethasone on the severity of persistent postsurgical pain after total knee arthroplasty: a prospective, randomized, double‐blind, placebo‐controlled trial. ClinicalTrials.gov: NCT02760459.
Sidhu 2017 {unpublished data only}
    1. Sidhu J. Perioperative ADministration of Dexamethasone and Infection trial. www.paddi.org.au (accessed 16 August 2018).
Wang 2018 {published data only}
    1. Wang DX. Dexamethasone, flurbiprofen, axetil and delirium after lung cancer surgery. ClinicalTrials.gov: NCT02300600. [Clinicaltrials.gov NCT03200600]

Additional references

Althumairi 2016
    1. Althumairi AA, Canner JK, Gearhart SL, Safar B, Sacks J, Efron JE. Predictors of perineal wound complications and prolonged time to perineal wound healing after abdominoperineal resection. World Journal of Surgery 2016;40(7):1755‐62. [PUBMED: 26908238 ] - PubMed
Assante 2015
    1. Assante J, Collins S, Hewer I. Infection associated with single‐dose dexamethasone for prevention of postoperative nausea and vomiting: a literature review. AANA Journal 2015;83(4):281‐8. [PUBMED: 26390747] - PubMed
Bartlett 2013
    1. Bartlett R, Hartle AJ. Routine use of dexamethasone for postoperative nausea and vomiting: the case against. Anaesthesia 2013;68(9):892‐6. [PUBMED: 23848377] - PubMed
Bolac 2013
    1. Bolac CS, Wallace AH, Broadwater G, Havrilesky LJ, Habib AS. The impact of postoperative nausea and vomiting prophylaxis with dexamethasone on postoperative wound complications in patients undergoing laparotomy for endometrial cancer. Anesthesia and Analgesia 2013;116(5):1041‐7. [PUBMED: 23337415 ] - PubMed
Busti 2005
    1. Busti AJ, Hooper JS, Amaya CJ, Kazi S. Effects of perioperative antiinflammatory and immunomodulating therapy on surgical wound healing. Pharmacotherapy 2005;25(11):1566‐91. [PUBMED: 16232020] - PubMed
Byrne 1989
    1. Byrne DJ, Malek MM, Davey PG, Cuschieri A. Postoperative wound scoring. Biomedical Pharmacotherapy 1989;43(9):669‐73. [PUBMED: 2696565] - PubMed
Carlisle 2012
    1. Carlisle JB. The analysis of 168 randomised controlled trials to test data integrity. Anaesthesia 2012;67(5):521‐37. [PUBMED: 22404311] - PubMed
Clement 2004
    1. Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, et al. American Diabetes Association Diabetes in Hospitals Writing Committee. Management of diabetes and hyperglycemia in hospitals. Diabetes Care 2004;27(2):553‐91. [PUBMED: 14747243] - PubMed
Corcoran 2010
    1. Corcoran TB, Truyens EB, Ng A, Moseley N, Doyle AC, Margetts L. Anti‐emetic dexamethasone and postoperative infection risk: a retrospective cohort study. Anaesthesia and Intensive Care 2010;38(4):654‐60. [PUBMED: 20715727] - PubMed
Dahl 2014
    1. Dahl RM, Wetterslev J, Jorgensen LN, Rasmussen LS, Moller AM, Meyhoff CS, et al. The association of perioperative dexamethasone, smoking and alcohol abuse with wound complications after laparotomy. Acta Anaesthesiologica Scandinavica 2014;58(3):352‐61. [PUBMED: 24471786] - PubMed
De Oliveira 2011
    1. Oliveira GS Jr, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta‐analysis of randomized controlled trials. Anesthesiology 2011;115(3):575‐88. [PUBMED: 21799397] - PubMed
De Oliveira 2013
    1. Oliveira GS Jr, Castro‐Alves LJ, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta‐analysis of randomized controlled trials. Anesthesia and Analgesia 2013;116(1):58‐74. [PUBMED: 23223115] - PubMed
Dindo 2004
    1. Dindo D, Demartines N, Clavien P‐A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery 2004;240(2):205‐13. [PUBMED: 15273542] - PMC - PubMed
Dungan 2009
    1. Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet 2009;373(9677):1798‐807. [PUBMED: 19465235] - PMC - PubMed
Durmus 2003
    1. Durmus M, Karaaslan E, Ozturk E, Gulec M, Iraz M, Edali N, et al. The effects of single‐dose dexamethasone on wound healing in rats. Anesthesia and Analgesia 2003;97(5):1377‐80. [PUBMED: 14570655] - PubMed
Eberhart 2006
    1. Eberhart LHJ, Kleine Büning E, Folz B, Maybauer DM, Kästner M, Kalder M, et al. Anti‐emetic prophylaxis with oral tropisetron and/or dexamethasone. European Journal of Clinical Investigation 2006;36:580‐7. [PUBMED: 16893381] - PubMed
Eberhart 2011a
    1. Eberhart LH, Holdorf S, Albert US, Kalder M, Kerwat K, Kranke P, et al. Impact of a single perioperative dose of dexamethasone on the incidence of surgical site infections: a case‐control study. Journal of Obstetrics and Gynaecology Research 2011;37(12):1807‐12. [PUBMED: 21794004] - PubMed
Eberhart 2011b
    1. Eberhart LH, Graf J, Morin AM, Stief T, Kalder M, Lattermann R, et al. Randomised controlled trial of the effect of oral premedication with dexamethasone on hyperglycaemic response to abdominal hysterectomy. European Journal of Anaesthesiology 2011;28(3):195‐201. [PUBMED: 21192268] - PubMed
Egger 1997
    1. Egger M, Smith GD, Philips AN. Meta‐analysis: principles and procedures. BMJ 1997;315(7121):1533‐7. [PUBMED: 9432252] - PMC - PubMed
Fauci 1976
    1. Fauci AS, Dale DC, Balow JE. Glucocorticosteroid therapy: mechanisms of action and clinical considerations. Annals of Internal Medicine 1976;84(3):304‐15. [PUBMED: 769625] - PubMed
Gali 2012
    1. Gali B, Burkle CM, Klingele CJ, Schroeder D, Jankowski CJ. Infection after urogynecologic surgery with the use of dexamethasone for nausea prophylaxis. Journal of Clinical Anesthesia 2012;24(7):549‐54. [PUBMED: 23101769 ] - PubMed
Gan 2014
    1. Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia and Analgesia 2014;118(1):85‐113. [PUBMED: 24356162] - PubMed
GradePro GDT [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed 15 April 2018. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Guyatt 2008
    1. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck‐Ytter Y, Schunemann HJ, et al. What is "quality of evidence" and why is it important to clinicians?. BMJ 2008;336(7651):995‐8. [PUBMED: 18456631] - PMC - PubMed
Habib 2012
    1. Habib AS, Gan TJ. Postoperative nausea and vomiting: then & now. Anesthesia and Analgesia 2012;115(3):493‐5. [PUBMED: 22910636] - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Horan 2008
    1. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care‐associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control 2008;36(5):309‐32. [PUBMED: 18538699] - PubMed
Hozo 2005
    1. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology 2005;5:13. [PUBMED: 15840177] - PMC - PubMed
Kranke 2014
    1. Kranke P, Diemunsch P. The 2014 consensus guidelines for the management of postoperative nausea and vomiting: a leapfrog towards a postoperative nausea and vomiting‐free hospital. European Journal of Anaesthesiology 2014;31(12):651‐3. [PUBMED: 25350527] - PubMed
Liu 2014
    1. Liu XX, Zhu XM, Miao Q, Ye HY, Zhang ZY, Li YM. Hyperglycemia induced by glucocorticoids in nondiabetic patients: a meta‐analysis. Annals of Nutrition and Metabolism 2014;65(4):324‐32. [PUBMED: 25402408] - PubMed
Murphy 2011b
    1. Murphy GS, Szokol JW, Greenberg SB, Avram MJ, Vender JS, Nisman M, et al. Preoperative dexamethasone enhances quality of recovery after laparoscopic cholecystectomy: effect on in‐hospital and postdischarge recovery outcomes. Anesthesiology 2011;114(4):882‐90. [PUBMED: 21297442] - PubMed
Parvizi 2011
    1. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clinical Orthopaedic and Related Research 2011;469(11):2992‐4. [PUBMED: 21938532] - PMC - PubMed
Pehora 2017
    1. Pehora C, Pearson AME, Kaushal A, Crawford MW, Johnston B. Dexamethasone as an adjuvant to peripheral nerve block. Cochrane Database of Systematic Reviews 2017, Issue 11. [DOI: 10.1002/14651858.CD011770.pub2] - DOI - PMC - PubMed
Percival 2010
    1. Percival VG, Riddell J, Corcoran TB. Single dose dexamethasone for postoperative nausea and vomiting ‐ a matched case‐control study of postoperative infection risk. Anaesthesia and Intensive Care 2010;38(4):661‐6. [PUBMED: 20715728] - PubMed
Polderman 2015b
    1. Polderman JA, Velzen L, Wasmoeth LG, Eshuis JH, Houweling PL, Hollmann MW, et al. Hyperglycemia and ambulatory surgery. Minerva Anestesiologica 2015; Vol. 81, issue 9:951‐9. [PUBMED: 25592489] - PubMed
Qi 2004
    1. Qi D, Pulinilkunnil T, An D, Ghosh S, Abrahani A, Pospisilik JA, et al. Single‐dose dexamethasone induces whole‐body insulin resistance and alters both cardiac fatty acid and carbohydrate metabolism. Diabetes 2004;53(7):1790‐7. [PUBMED: 15220203] - PubMed
Review Manager 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
SanGiovanni 2016
    1. SanGiovanni TP, Kiebzak GM. Prospective randomized evaluation of intraoperative application of autologous platelet‐rich plasma on surgical site infection or delayed wound healing. Foot & Ankle International 2016;37(5):470‐7. [PUBMED: 26683126] - PubMed
Smiley 2006
    1. Smiley DD, Umpierrez GE. Perioperative glucose control in the diabetic or nondiabetic patient. Southern Medical Journal 2006;99(6):580‐9; quiz 590‐1. [PUBMED: 16800413] - PubMed
Sutton 2002
    1. Sutton AJ, Cooper NJ, Lambert PC, Jones DR, Abrams KR, Sweeting MJ. Meta‐analysis of rare and adverse event data. Expert Review of Pharmacoeconomics & Outcomes Research 2002;2(4):367‐79. [PUBMED: 19807443] - PubMed
Toner 2017
    1. Toner AJ, Ganeshanathan V, Chan MT, Ho KM, Corcoran TB. Safety of perioperative glucocorticoids in elective noncardiac surgery. Anesthesiology 2017;126(2):234‐48. [PUBMED: 27922839] - PubMed
Turina 2005
    1. Turina M, Fry DE, Polk HC Jr. Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Critical Care Medicine 2005;33(7):1624‐33. [PUBMED: 16003073] - PubMed
Waldron 2013
    1. Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side‐effects: systematic review and meta‐analysis. British Journal of Anaesthesia 2013;110(2):191‐200. [PUBMED: 23220857] - PMC - PubMed

References to other published versions of this review

Polderman 2015a
    1. Polderman JAW, Farhang‐Razi V, Dieren S, Kranke P, DeVries JH, Hollmann MW, et al. Adverse side effects of dexamethasone in surgical patients. Cochrane Database of Systematic Reviews 2015, Issue 11. [DOI: 10.1002/14651858.CD011940] - DOI
Polderman 2018
    1. Polderman JAW, Farhang‐Razi V, Dieren S, Kranke P, DeVries JH, Hollmann MW, et al. Adverse side effects of dexamethasone in surgical patients. Cochrane Database of Systematic Reviews 2018, Issue 8. [DOI: 10.1002/14651858.CD011940.pub2] - DOI - PMC - PubMed

Publication types

MeSH terms