Dexamethasone
Decadron
Long-acting glucocorticoid
Glucocorticoid receptor agonist — anti-inflammatory, antiemetic, prolongs PNB duration.
Indications
- •PONV prophylaxis
- •PNB adjunct (prolongs block)
- •Anti-inflammatory (airway edema, post-tonsillectomy)
- •Cerebral edema
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| PONV prophylaxis | 4–8 mg IV at induction | 0.15 mg/kg IV (max 8 mg) |
| Airway edema | 0.5–1 mg/kg q6 h | — |
| Cerebral edema | 10 mg IV load, 4 mg q6 h | — |
Pharmacokinetics
Onset 1 h (antiemetic). Duration 24–72 h.
Side effects
- !Transient hyperglycemia (clinically significant in diabetics — dose ≤ 4 mg)
- !Perineal pruritus on rapid IV push (dilute + slow injection)
- !Adrenal suppression with chronic use
- !Wound infection risk (single intraop dose minimal effect)
Contraindications
- ×Active untreated infection (relative)
Clinical pearls
- ★Single intraop 4–8 mg has dual antiemetic + analgesic-prolongation effect.
- ★Perineal burning warning — common in awake patients receiving rapid push.
Other drugs in Steroids
- Methylprednisolone
Binds intracellular glucocorticoid receptor → translocation to nucleus → transcriptional regulation of anti-inflammatory genes (lipocortin-1, IL-10) + suppression of pro-inflammatory genes (NF-κB, COX-2). 5× the glucocorticoid potency of hydrocortisone with minimal mineralocorticoid activity.
- Hydrocortisone
Endogenous cortisol equivalent. Binds both glucocorticoid AND mineralocorticoid receptors — 1× glucocorticoid potency (reference standard), substantial mineralocorticoid effect (sodium retention, K⁺ excretion). The replacement steroid for adrenal insufficiency.
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