Re: Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)
I read with interest the results of the DREAMS trial, demonstrating the benefit of a single dose of Dexamethasone at induction of anaesthesia providing significant benefit for prevention of post-operative nausea and vomiting (PONV) (1). This trial was even more interesting due to the assessment of many different factors influencing the benefit. Admittedly it was published in 2017 so I apologise for my delayed interest.
As you’ll be aware, psychiatric side effects remain common but significant adverse effects of systemic corticosteroid treatment, with potent corticosteroids being a large culprit (2). It’s even been suggested that up to 25% of those treated with systemic corticosteroids are unfortunate to experience these distressing side effects, including depression, psychotic episodes and mania (3). Some of these patients require admission to a psychiatric institution and will incorrectly be diagnosed with disorders such as Bipolar Disorder or as having psychotic disorders.
I note your assessment of the adverse outcomes including wound infections, urinary tract infections, respiratory infections, anastomotic leaks and abdominal abscess development. I also note sepsis and GI bleeds that could be considered related or unrelated to the study.
I wonder whether the collaborators of the study considered the inclusion of acute psychiatric disturbance as a measurable adverse outcome of the administration of Dexamethasone. If not, would this be an area the collaborators see as being important for future investigation to assess the true safety profile of Dexamethasone for the prevention of PONV in all patients, including those with major psychiatric history?
1. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial). BMJ. 2017 Apr 18;
2. Brown ES, Chandler PA. Mood and Cognitive Changes During Systemic Corticosteroid Therapy. The Primary Care Companion to The Journal of Clinical Psychiatry. 2001 Feb 1;03(01).
3. Warrington TP, Bostwick JM. Psychiatric Adverse Effects of Corticosteroids. Mayo Clinic Proceedings. 2006 Oct;81(10).
Competing interests: No competing interests