Re: Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)
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Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)
Re: Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)
The DREAMS study certainly helps ratify what has become a routine practice for the prophylaxis of post-operative nausea and vomiting, particularly within the context of enhanced recovery.
The decision to choose a dose of 8mg of dexamethasone seems curious, however. The most recent consensus guidelines on postoperative nausea and vomiting suggest a dose of 4mg as a balance between risk and benefit. a dose finding study would be useful.
Another confounding factor is the use of intraoperative opioids. Whilst data appears to have been collected on which opioids were administered during each procedure, the route and dose do not appear to have been taken into consideration. There is likely to be a difference in emetic properties - did the authors consider this? A small dose of intrathecal morphine is likely to have different effects to a larger intravenous dose of morphine, however these seem to be grouped together. Perhaps a subgroup analysis would be possible?
Thank you for your contribution to the care of these patients.
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Re: Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)
The DREAMS study certainly helps ratify what has become a routine practice for the prophylaxis of post-operative nausea and vomiting, particularly within the context of enhanced recovery.
The decision to choose a dose of 8mg of dexamethasone seems curious, however. The most recent consensus guidelines on postoperative nausea and vomiting suggest a dose of 4mg as a balance between risk and benefit. a dose finding study would be useful.
Another confounding factor is the use of intraoperative opioids. Whilst data appears to have been collected on which opioids were administered during each procedure, the route and dose do not appear to have been taken into consideration. There is likely to be a difference in emetic properties - did the authors consider this? A small dose of intrathecal morphine is likely to have different effects to a larger intravenous dose of morphine, however these seem to be grouped together. Perhaps a subgroup analysis would be possible?
Thank you for your contribution to the care of these patients.
Competing interests: No competing interests