Questions · Perioperative Dexamethasone
9 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
In a pooled analysis of 60 randomised trials of dexamethasone for postoperative nausea and vomiting, how did 4-5 mg compare with 8-10 mg for nausea and vomiting in the first 24 hours, and which dose recommendation does that support?
Answer: Pooled across the 60 trials, 4-5 mg reduced 24-hour nausea and vomiting as effectively as 8-10 mg, supporting the lower SAMBA-recommended dose.
For antiemesis the bigger dose bought nothing: across 60 trials 4-5 mg matched 8-10 mg at 24 hours, which is why the lower SAMBA dose is recommended.
Source claim: Pooled across 60 trials, 4-5 mg of dexamethasone reduced 24-hour nausea and vomiting as effectively as 8-10 mg, supporting the lower SAMBA-recommended dose.
Dexamethasone to Prevent Postoperative Nausea and Vomiting: An Updated Meta-Analysis of Randomized Controlled Trials, Anesthesia and analgesia 2013
recall · CA-1 · phrased by llm
In the PADDI trial, 8 mg of dexamethasone was compared with placebo. State the 30-day surgical-site infection result with its rates, name the type of statistical comparison used for that outcome, say whether it held in patients with diabetes, and give the effect on nausea and vomiting.
Answer: Dexamethasone 8 mg was noninferior to placebo for surgical-site infection at 30 days, 8.1% versus 9.1%, and this included patients with diabetes. Nausea and vomiting fell from 53.9% to 42.2%. The infection comparison was a noninferiority comparison, not a demonstration that dexamethasone lowers infection.
PADDI is what to cite when someone withholds dexamethasone over infection risk: 8 mg was noninferior for 30-day surgical-site infection, diabetes included, while cutting nausea and vomiting from 53.9% to 42.2%.
Source claim: In PADDI, 8 mg of dexamethasone was noninferior to placebo for surgical-site infection at 30 days (8.1% versus 9.1%), including in patients with diabetes, while cutting nausea and vomiting from 53.9% to 42.2%.
Dexamethasone and Surgical-Site Infection, The New England journal of medicine 2021
recall · CA-2 · phrased by llm
A meta-analysis of single-dose systemic dexamethasone examined its analgesic rather than antiemetic effect. State the dose threshold above which pain and opioid consumption were reduced, what happened at low doses, and whether preoperative or intraoperative administration produced the more consistent effect.
Answer: For analgesia the dose matters: doses above 0.1 mg/kg reduced pain and opioid consumption, low doses did not, and preoperative administration gave a more consistent effect than intraoperative.
Analgesia and antiemesis are two different dose questions for the same drug: the analgesic effect only showed up above 0.1 mg/kg, and it was more consistent when the dose went in preoperatively.
Source claim: For analgesia rather than antiemesis the dose matters: doses above 0.1 mg/kg reduced pain and opioid consumption, low doses did not, and preoperative administration gave a more consistent effect than intraoperative.
Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials, Anesthesiology 2011
recall · CA-2 · phrased by llm
A multicentric cohort study of 30,561 oncologic resections examined intraoperative dexamethasone. Summarise its findings for 1-year mortality, recurrence-free survival, hyperglycaemia, and surgical-site infection, then state precisely why these findings cannot be used to recommend dexamethasone in order to improve cancer outcomes.
Answer: Dexamethasone was associated with lower 1-year mortality and better recurrence-free survival, while doses above 0.09 mg/kg raised hyperglycaemia without raising surgical-site infection. These are associations from a cohort study, not randomised effects, so they cannot establish that dexamethasone improves cancer outcomes or justify giving it for that reason.
An association across 30,561 patients is a hypothesis worth testing, not a reason to give dexamethasone for oncologic benefit.
Source claim: Among 30,561 oncologic resections, dexamethasone was associated with lower 1-year mortality and better recurrence-free survival, while doses above 0.09 mg/kg raised hyperglycaemia without raising surgical-site infection.
Association Between Intraoperative Dexamethasone and Postoperative Mortality in Patients Undergoing Oncologic Surgery: A Multicentric Cohort Study, Annals of surgery 2023
recall · CA-3 · phrased by llm
High-dose dexamethasone at ___ mg/kg in cardiac surgery did not reduce 30-day major adverse events (7.0% versus 8.5%); it lowered infection and ventilation time but raised postoperative glucose.
Answer: 1
High-dose dexamethasone at 1 mg/kg in cardiac surgery did not reduce 30-day major adverse events (7.0% versus 8.5%); it lowered infection and ventilation time but raised postoperative glucose.
Intraoperative High-Dose Dexamethasone for Cardiac Surgery: A Randomized Controlled Trial · PMID 23117776
recall · CA-1 · phrased by derived
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open · CA-1 · phrased by derived
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open · CA-1 · phrased by derived
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