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Canadian Journal of Anesthesia 51:398-399 (2004)
© Canadian Anesthesiologists' Society, 2004

Correspondence

REPLY

Philippe Béchard, MD MSc FRCPC, Pierre Dolbec, MD FRCPC, Julie Germain, MD FRCPC and Gino Perron, MD FRCPC

Lévis, Québec

We would like to thank Dr. Crandell for his interest and comments regarding perineal pruritus after iv dexamethasone administration.1 We agree with the fact that administrating dexamethasone immediately after the induction of general anesthesia is probably as effective as administrating it before induction. Since our report, we adopted the same strategy of giving dexamethasone after the induction of general anesthesia to avoid perineal pruritus.

Wang et al. reported that dexamethasone was not effective zero to two hours after its administration, but that it proved to be effective in the following period.2 This finding probably explains the lower incidence of early postoperative nausea and vomiting observed in the group of patients receiving dexamethasone before the induction of general anesthesia in Wang’s study since the mean duration of anesthesia in this group was 136 min. Nevertheless, further research is needed to clarify the onset time of dexamethasone’s antiemetic effect and to determine if the timing of its administration relative to induction of general anesthesia could really affect its efficacy.

Since dexamethasone may be needed in awake patients in the postanesthesia care unit, the step down recovery unit or on the ward, anesthesiologists should inject the drug slowly over five to ten minutes to prevent perineal irritation and patient discomfort.3–5

References

1 Perron G, Dolbec P, Germain J, Bechard P. Perineal pruritus after iv dexamethasone administration (Letter). Can J Anesth 2003; 50: 749–50.[Free Full Text]

2 Wang JJ, Ho ST, Tzeng JI, Tang CS. The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg 2000; 91: 136–9.[Abstract/Free Full Text]

3 Thomas VL. More on dexamethasone-induced perineal irritation (Letter). N Engl J Med 1986; 314: 1643–4.[Medline]

4 Andrews D, Grunau VJ. An uncommon adverse effect following bolus administration of intravenous dexamethasone. J Can Dent Assoc 1986; 52: 309–11.

5 Czerwinski AW, Czerwinski AB, Whitsett TL, Clark ML. Effects of a single, large, intravenous injection of dexamethasone. Clin Pharmacol Ther 1972; 13: 638–42.[Medline]


Related articles in CJA:

Perineal pruritus after the administration of iv dexamethasone
James T. Crandell
CJA 2004 51: 398. [Full Text]  




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