Effects of Intraoperative Dexamethasone Administration in Adult Diabetic Burn Patients.

The steroid dexamethasone is used intraoperatively to prevent postoperative nausea. Studies of intraoperative steroid use in diabetic patients have shown conflicting effects on blood glucose and complications, and their use has not yet been studied in the burn population. A review of adult diabetic acute burn patients undergoing surgery at a verified burn center from 2012 to 2017 was conducted. Statistical analysis compared those who did and did not receive an intraoperative steroid. A total of 74 patients who underwent 121 operations were identified; steroid was administered in 14.0% of cases. There were no statistically significant differences in preoperative glucose, insulin requirements, TBSA, or hemoglobin A1C. Postoperatively, the steroid group had a 16.7 mg/dl (SD = 11.1) increase in blood glucose (P = .042) and 53.5 unit/24 hour (SD = 28.4) increase in insulin requirement (P = .019), compared with no change in controls. The complication rate in the steroid group was 52.9% compared with 20.1% in controls (P = .003); partial graft loss was the most common complication. Diabetic burn patients who receive intraoperative steroid have increased postoperative blood glucose levels, insulin requirements, and complication rates compared with patients who do not receive steroids. Discussion is warranted to avoid intraoperative steroid in this population.

Safety and efficacy of commonly used antiemetics.

INTRODUCTION: Clinicians use antiemetic drugs in a multitude of scenarios. Despite the differences in subspecialty and etiology of the nausea, practitioners of all subspecialties use the same drugs in similar ways to provide relief for their patients. AREAS COVERED: Multiple classes of antiemetics are used frequently but no single treatment course works for all types of patients. The complex etiology of nausea often requires a multimodal approach that targets the same symptom through different sites of action. Antiemetics have unique side effects and safety profiles which are covered in this review. Antihistamines, phenothiazines, corticosteroids, benzamindes, anticholinergic, neurokinin-1 antagonists, 5-HT3 receptor antagonist and cannabinoids are discussed. These drugs were evaluated based on an in-depth literature review including a review of the original research that led to many of the drugs initial FDA approval, via internet and PubMed searches. EXPERT OPINION: The key to providing relief for patients suffering from nausea and vomiting is to consider multiple drugs to approach the nausea in a systematic way. Anesthesiologists identify patients who are at high risk of nausea and vomiting based on physical characteristics and surgical procedures. Oncologists treat nausea based on the prescribed chemotherapeutics regimen and known risk of emesis while palliative care physicians and others balance the etiology of the nausea while optimizing patients other co morbid conditions.