December FY24

[A Schutter]

December Journal Club is presented by Belinda Gardner, CRNA she chose an article from AANA regarding use of Single dose Dexamethasone in patients with diabetes undergoing surgery.

Postoperative nausea and vomiting (PONV) remains a common complication after surgery that can lead to prolonged length of stay in the post anesthesia care unit (PACU), increased readmission rates, increases in healthcare costs and adversely impact patient satisfaction. There are several evidence-based strategies for managing PONV and it is recommended to use a multimodal approach to PONV prevention in patients with one or more risk factors. Dexamethasone is currently one of the most used drugs for PONV prophylaxis; however, even a single dose of dexamethasone is associated with causing transient increases in blood glucose concentrations within 24 hours of administration

Here is a link to the article.

The two questions for discussion:
1. Do you routinely give Dexamethasone for PONV prophylaxis? If so what dose do you give and do you use it in the diabetic population?

2. After reviewing this article do you think your practice will change? Do you think it is a good study?

[sjsimmons]

1. I routinely give 4 mg of dexamethasone in patients with a 2 or more risk factors for PONV, such as a history of PONV, female, young, nonsmoker. I try to avoid dexamethasone in the diabetic population unless the patient reports a history of PONV.

2. I believe this is a good study - randomized controlled trials present a strong level of evidence and the results of this study are consistent with the results of similar studies. The standard of practice should be based on current literature so I plan to change my practice to include dexamethasone for PONV prophylaxis.

[Jessica Hadley]

1. I do give Dexamethasone to patients with higher risk factors for PONV, whose cases are not cancer related. I use Dexamethasone sparingly in the diabetic population, if a patient with DM is high risk for PONV and their BG on the day of surgery is well controlled then I consider one 4mg dose of Dexamethasone.

2. I don't think my practice will change, however I did like that the review cited an average rise in BG following a dose of Dexamethasone.

[Sarah Jazzar]

1) I weigh the risks and benefits when administering Dexamethasone and the dose. For example, I consider the patient's risk for PONV and if the patient has DM. Depending on the DM pt's blood sugar, if it is within an acceptable range, I'll give 4 mg of Decadron. Otherwise, I use an alternative regimen.

2) This study supports that patient's medical history should be considered when administering dexamethasone. I will continue my practice but will keep in mind the average increase in blood sugar after a single dose of dexamethasone.

[kels]

1. Do you routinely give Dexamethasone for PONV prophylaxis? NO
If so what dose do you give and do you use it in the diabetic population? I tend to give 4 mg of Dexamethasone and I tend to avoid this drug in the diabetic population.

2. After reviewing this article do you think your practice will change? Do you think it is a good study? Good study. I don't think my practice will change.

[Amy Swank]

1. I do routinely give Decadron unless the patient has diabetes. If the patient is not diabetic, I usually give 4 mg unless there has been an above average amount of airway manipulation or trauma or an ENT case, then I will give 8mg.

2. I do not thing my practice will change - I will continue to give dexamethasone unless the administration would cause an elevated postoperative blood glucose level 1-4 hrs after dosing.

Thank you for the excellent reminder.

[Jackie Howell]

1. I routinely give 4-8 mg of Decadron for PONV prophylaxis. I, like many who have already posted, weigh the risk vs benefits in the diabetic population. 
2. I am likely to not change my practice, this was a good study and interesting to read. 

[Benjamin Waldbaum]

I routinely give 4 mg of Dexamethasone for PONV prophylaxis and I do not use it in diabetics unless specifically requested by surgical team due to surgical considerations.

There was nothing in the article that I found surprising or that will change my practice, especially because of the small sample size.

[aileenm4]

1. I do not give Decadron to every patient .I only give Decadron routinely in specific cases like airway cases , however, I do consider each patients co existing diseases like DM or oncology status. I do not give Decadron to patients with DM unless discussion with team as in the specific needs like airway swelling. I use alternate plans for PONV in high risk patients like TIVA if I cant add in Decadron.

2. I do not think this study will change my practice

[Wai-Ling Lo]

1. Do you routinely give Dexamethasone for PONV prophylaxis? If so what dose do you give and do you use it in the diabetic population?
I assess each case to decide whether dexamethasone is appropriate. I usually don't give it to DM or cancer cases. I prefer to use TIVA for PONV cases. IF I do give it, the dose will be 4mg.

2. After reviewing this article do you think your practice will change? Do you think it is a good study?
I won't change my practice after reviewing this article. Like Ben said, the sample size is small. But it is nice to review the average rise of BG after giving decadron.