Single Dose Of Intravenous Dexamethasone Research Articles

The place of corticosteroids in migraine attack management: A 65-year systematic review with pooled analysis and critical appraisal.

Headaches recur in up to 87% of migraine patients visiting the emergency department (ED), making ED recidivism a management challenge. We aimed herein to determine the role of corticosteroids in the acute management of migraine in the ED and outpatient care. Advanced search strategies employing PubMed/MEDLINE, Web of Science, and Cochrane Library databases inclusive of a relevant gray literature search was employed for Clinical Studies and Systematic Reviews by combining the terms "migraine" and "corticosteroids" spanning all previous years since the production of synthetic corticosteroids ca. 1950 until August 30, 2014. Methods were in accordance with MOOSE guidelines. Twenty-five studies (n = 3989, median age 37.5 years, interquartile range or IQR 35-41 years; median male:female ratio 1:4.23, IQR 1:2.1-6.14; 52% ED-based, 56% randomized-controlled) and four systematic reviews were included. International Classification of Headache Disorders criteria were applied in 64%. Nineteen studies (76%) indicated observed outcome differences favoring benefits of corticosteroids, while six (24%) studies indicated non-inferior outcomes for corticosteroids. Median absolute risk reduction was 30% (range 6%-48.2%), and 11% (6%-48.6%) for 24-, and 72-hour headache recurrence, respectively. Parenteral dexamethasone was the most commonly (56%) administered steroid, at a median single dose of 10 mg (range 4-24 mg). All meta-analyses revealed efficacy of adjuvant corticosteroids to various abortive medications-indicating generalizability. Adverse effects were tolerable. Higher disability, status migrainosus, incomplete pain relief, and previous history of headache recurrence predicted outcome favorability. Our literature review suggests that with corticosteroid treatment, recurrent headaches become milder than pretreated headaches and later respond to nonsteroidal therapy. Single-dose intravenous dexamethasone is a reasonable option for managing resistant, severe, or prolonged migraine attacks.

The preoperative single dose dexamethasone effect to pro-and anti-inflammatory cytokine during orthopedic surgery

Background: The efficacy of glucocorticoids like dexamethasone in reducing postoperative pain has been investigated and showed that a single dose of dexamethasone significantly analgesia has advantages in terms of reduction in pain intensity, opioid requirements, rescue analgesia, and did not increase the incidence of infection and impaired wound healing. The aim of this study was to evaluate the effects of preoperative single dose of intravenous dexamethasone to the dynamics of pro- and anti-inflammatory cytokine in orthopedic surgery perioperative period. Materials and Methods: Thirty patients were studied and randomly into two groups: 15 patients received 8 mg dexamethasone intravenous preoperatively and perioperative analgesia with paracetamol and patient-controlled analgesia (PCA) morphine (dexamethasone group) and 15 patients received perioperative analgesia paracetamol and PCA morphine only (control group). Blood samples were taken at the time before anesthesia, immediately postsurgery, 4 h and 24 h after surgery to measure plasma levels of interleukin 6 (IL-6) and IL-10. We recorded the pain intensity and morphine requirement in 4 h and 24 h after surgery. Results: IL-6 levels in the dexamethasone group did not increased from immediately after surgery to 24 h after surgery but increased in the control group ( P P Conclusion: The addition of dexamethasone preoperatively on the combination of paracetamol and morphine did not change plasma levels of IL-6 and IL-10 cytokines Dexamethasone provides sufficient analgesia and decrease postoperative opioid requirement.

The Effect of Dexamethasone on the Dynamics of Inflammation, Cortisol and analgesia in Lower Limb Surgery

Background: Dexamethasone is currently used as a part of multimodal analgesia on postoperative pain management. Dexamethasone considered providing effective analgesia as a steroid anti-inflammatory. This study aimed to examine the effects of preoperative single dose of intravenous dexamethasone to the inflammation, cortisol response and analgesia in lower limb surgery. Methods: This is a clinical experimental study conducted in randomized double-blind trial performed at Wahidin Sudirohusodo Hospital, Makassar Indonesia. Thirty patients with lower limb surgery under spinal anesthesia meet the inclusion criteria were randomly divided into 2 groups: (1) group received 8 mg dexamethasone intravenous preoperatively and perioperative analgesia with paracetamol and PCA morphine (dexamethasone group) and (2) group received perioperative analgesia paracetamol and PCA morphine (control group). Blood samples were taken at the time before anesthesia, immediately post-surgery, 4 and 24 hours after surgery to measure plasma levels of CRP and Cortisol with the ELISA test. We recorded the intensity of rest pain and morphine requirement in 4 and 24 hours after surgery. Results: Both of groups found increase in CRP plasma levels at the 24 hours after surgery (p<0.05). Cortisol in the dexamethasone group decreased significantly at the 24 hours after surgery while in the control group did not change (p<0.05). Rest pain intensity and morphine requirement in the dexamethasone group was lower in the 24 hours after surgery than the control group (p<0.05). No differences changes in blood pressure, heart rate, respiration and the side effects between the two groups. Conclusion: The addition of single dose dexamethasone preoperatively on the combination of paracetamol and morphine did not abolish inflammation process but decrease cortisol response after surgery with sufficient analgesia and minimal side effect.

Low incidence of early postoperative cerebral edema after coronary artery bypass grafting.

Using magnetic resonance imaging, the authors studied the influence of a single high dose of intraoperative dexamethasone on the severity of cerebral edema that can occur early after coronary artery bypass grafting (CABG). It was hypothesized that high-dose intraoperative dexamethasone reduces cerebral edema after CABG. Secondary analysis in a subset of participants of the Dexamethasone for Cardiac Surgery (DECS) trial. The DECS trial was a multicenter, randomized, double-blind, placebo-controlled trial in 4,494 cardiac surgery patients, which studied the effect of high-dose dexamethasone on mortality and major complications after cardiac surgery. A large university hospital in The Netherlands. Twenty adult patients who underwent CABG with cardiopulmonary bypass (CPB) between March and November 2011. Participants received a single intravenous dose of dexamethasone, 1 mg/kg, or placebo, at induction of anesthesia. Patients underwent magnetic resonance imaging scanning immediately after surgery. The primary outcome was the severity of cerebral edema. Data from 18 patients (9 in each group, median age 69 years in both groups) could be analyzed. Patients in the dexamethasone group were (median, interquartile range 66 (53-99) minutes on cardiopulmonary bypass v 95 (81-105) minutes in the placebo group (p = 0.11). Only 1 patient in the dexamethasone group had slight cerebral edema (0% v 11%, p = 1.00), and edema severity did not differ between groups (p = 1.00). Relevant degrees of early postoperative cerebral edema were not observed. The present study findings strongly contrasted with older studies showing cerebral edema early after CABG in most patients.

Does a single dose of intravenous dexamethasone reduce Symptoms in Emergency department patients with low Back pain and RAdiculopathy (SEBRA)? A double-blind randomised controlled trial

ObjectiveTo assess the effect of a single dose of intravenous dexamethasone in addition to routine treatment on visual analogue scale (VAS) pain scores at 24 h in emergency department (ED)...

The effect of single-dose administration of dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy.

Background:Postoperative pain is considered as a reason of patient’s delay in discharge and disability aggravation. Therefore, multimodal approaches have been suggested in order to mitigate pain and decrease postoperative side effects.Objectives:The aim of this study was to evaluate analgesic effect of a single dose injection of dexamethasone on reducing postoperative pain in laparoscopic cholecystectomy.Patients and Methods:In this double-blind, prospective study, 122 patients aged 18-60 years old, whom were selected for laparoscopic cholecystectomy, were classified into two case and control groups, and 61 patients were included in each group. The case (D) group underwent general anesthesia and a single- dose intravenous injection of dexamethasone. The Control (C) group received general anesthesia and intravenous injection of normal saline. Total dose of consumed meperidine and pain intensity during first 24 hours were evaluated in both groups.Results:No significant difference existed between two groups regarding age, sex, weight and operation time. Pain intensity in group D was significantly less than group C (P < 0.01) after two, six and 12 hoursof surgery. No significant difference existed in pain intensity between two groups at the beginning of and 24 hours after the surgery (P > 0.05). Meperidine consumption in group D was significantly less than group C (P < 0.05).Conclusions:Findings of present study showed that single dose of intravenous dexamethasone, led to less pain intensity and amounts of meperidine consumption, in comparison with placebo.

The Effect of Dexamethasone on Post-operative Opioid Requirement in Patients who Underwent Gynecology Surgery at the University Hospital in Jamaica

Background: The necessity to improve post-operative analgesia and hence patients’ satisfaction has been the driving force of the quest for easy-to-administer, cost effective and safe analgesic agents. Dexamethasone is a powerful anti-inflammatory, analgesic and anti-emetic agent, that has been found to decrease opioid use, yet improve post-operative analgesia in a wide range of surgical patients. Objectives: To determine if a single dose of intravenous Dexamethasone (0.5 mg/kg, not exceeding 40 mg), administered preoperatively, decreased post-operative opioid requirements without adverse effects in a cohort of Jamaican patients. Study design: A randomized, single-centre, single-blinded study was conducted over a six (6) month period. Patients, 18-60 years, scheduled to undergo gynecological surgery under general anesthesia, were recruited for the study, and were enrolled in either Group A, the control or B, the study group. Anesthesia was standardized and included intravenous Morphine (0.1 mg/kg) and Diclofenac sodium 75 mg, for preemptive analgesia. Pain intensity, sedation level, post-operative opioid/narcotic usage and satisfaction with pain management were assessed at 3, 6, 9 and 12 hours post-operatively. Results: Total Pethidine consumption for the control group (A) was significantly higher (5200 mg) than the study Group (B), 3800 mg (p=0.008). Age of patients and length of surgery were not found to influence Pethidine requirements (p=0.338 and 0.131 respectively). Pain intensity was significantly lower in Group B at the 12-hour assessment, p=0.019, and earlier discharge home was also noted. No adverse effects of Dexamethasone were observed. Conclusion: A single intravenous dose of Dexamethasone had a positive effect on post-operative pain management and patient satisfaction in a cohort of Jamaican patients.

A prospective study to compare the effects of pre,intra and post operative steroid (dexamethasone sodium phosphate) on post tonsillectomy morbidity

Objective:To determine the effectiveness of dexamethasone on post tonsillectomy morbidities in patients with chronic tonsillitis.Materials and Methods:In this randomized double-blind study, 100 patients who underwent tonsillectomy were enrolled and were randomly allocated into control or dexamethasone group (pre operative, intra operative and post operative groups). Patients were assessed for pain nausea, vomiting and oral intake in the post operative period at 24 h.Results:Patients treated with dexamethasone particularly in the pre and intra operative groups (Group B, Group C) showed a general trend towards lower pain score than post operative group (Group D). The scores were about 1.72±0.84 and 2.20±1.19 in Groups B and C respectively, and 2.64±0.99 in Group D. Overall pain score was found to be more in the control Group A about 4.84±1.21 at 6 h post operatively and showed similar trend for next 24 h. Total number of patients with nausea was significantly high about 84% in control group compared to dexamethasone groups (Group B, C and D) about 20%, 8% and 24% respectively and also incidence of vomiting episodes showed a similar trend. Oral intake was significantly delayed in control group (6.16 ±1.52), P < 0.001 than dexamethasone group. Pre operative and intra operative groups showed early intake (3.68±0.68) and (3.60±1.12) respectively than the postoperative group (5.08±0.95).Conclusions:A single intravenous dose of dexamethasone, given following induction of anaesthesia and at the time of surgery, provided prolonged analgesia, reduced nausea and vomiting and resulted in earlier oral intake.

Steroids for improving recovery following tonsillectomy in children

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2003.Tonsillectomy continues to be one of the most common surgical procedures performed worldwide. Despite advances in anesthetic and surgical techniques, post-tonsillectomy morbidity remains a significant clinical problem. To assess the clinical efficacy of a single intraoperative dose of dexamethasone in reducing post-tonsillectomy morbidity. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN; and additional sources for published and unpublished trials. The date of the most recent search was 29 October 2010, following a previous search in September 2002. Randomized, double-blind, placebo-controlled trials of a single dose of intravenous, intraoperative corticosteroid for pediatric patients (age < 18 years) who underwent tonsillectomy or adenotonsillectomy. The first author extracted data regarding the primary outcome measures and measurement tools from the published studies. The first author also recorded data regarding study design, patient ages, procedures performed, dose of corticosteroid and method of delivery, as well as methodological quality. When data were missing from the original publications, we contacted the authors for more information. We performed data analysis with a random-effects model, using the RevMan 5.1 software developed by the Cochrane Collaboration. We included 19 studies (1756 participants). We selected only randomized, placebo-controlled, double-blinded studies to minimize inclusion of poor quality studies. However, the risk of bias in the included studies was not formally assessed. Children receiving a single intraoperative dose of dexamethasone (dose range = 0.15 to 1.0 mg/kg) were half as likely to vomit in the first 24 hours compared to children receiving placebo (risk ratio (RR) 0.49; 95% confidence interval (CI) 0.41 to 0.58; P < 0.00001). Routine use in five children would be expected to result in one less patient experiencing post-tonsillectomy emesis (risk difference (RD) -0.24; 95% CI -0.32 to -0.15; P < 0.00001). Children receiving dexamethasone were also more likely to advance to a soft/solid diet on post-tonsillectomy day one (RR 1.45; 95% CI 1.15 to 1.83; P = 0.001) than those receiving placebo. Finally, postoperative pain was improved in children receiving dexamethasone as measured by a visual analog scale (VAS, 0 to 10) (MD -1.07; 95% CI -1.73 to -0.41; P = 0.001), which correlates clinically to a reduction in pain (on a VAS of 0 to 10) from 4.72 to 3.65. No adverse events were noted in the included studies. The evidence suggests that a single intravenous dose of dexamethasone is an effective, safe and inexpensive treatment for reducing morbidity from pediatric tonsillectomy.

Preoperative single-dose intravenous dexamethasone during ambulatory surgery: update around the benefit versus risk

Pain, emesis, and fatigue are not uncommon symptoms after ambulatory surgery having impact on patients' satisfaction with quality of care. Multimodal management of postoperative pain and nausea and vomiting has become standard of care. There is a growing body of evidence for the beneficial effects from preoperative single-dose intravenous (i.v.) glucocorticoids for reducing pain, emesis, and fatigue, thereby improving the recovery process and patient satisfaction. Side-effects are infrequently reported. The benefits versus risk associated to single preoperative i.v. dose of dexamethasone seem positive based on current evidence facilitating the recovery reducing pain and postoperative nausea and vomiting.

Single premedication dose of dexamethasone 20 mg IV before docetaxel administration

The administration of docetaxel requires the use of dexamethasone for the prevention of hypersensitivity reactions (HSRs) and fluid retention reactions (FRRs). The manufacturer recommends dexamethasone for 3 days starting the day before docetaxel. This regimen has the potential for nonadherence so the utility of a single dexamethasone dose would be welcomed. To ascertain the incidence of HSRs and FRRs after receiving a single dose of intravenous dexamethasone before docetaxel administration. Retrospective chart review. Data set from an oncology clinic affiliated with a large, tertiary, academic, teaching hospital. Ninety patients (median age 59 years, range 40-92 years) with cancer (primarily breast cancer, nonsmall cell lung cancer and head/neck cancer) who received docetaxel. Patients with heart failure, renal failure, chronic edema, current steroid use and/or prostate cancer were excluded from the study. Seven patients (7.8%) experienced a HSR requiring a treatment intervention (fluid bolus, oxygen, steroid, and/or diphenhydramine). Eleven patients (12.2%) had documented fluid retention. The mean docetaxel dose at the onset of fluid retention was 247.2 ± 134.5 mg/m(2). This single center evaluation with a small sample size had the potential for incomplete collection of the adverse events from the medical records due its retrospective nature. Hypersensitivity reactions and FRRs occurred in 7.8% and 12.2% of patients, respectively. This is lower than the rates reported by the manufacturer with the oral premedication regimen.

Role of Dexamethasone on Reducing Post Tonsillectomy Morbidities

Pain, nausea, vomiting, oedema and poor oral intake are the most common morbidities after general anesthesia and surgery like tonsillectomy. This study was done to evaluate the effectiveness of intravenous dexamethasone (0.15mg/kg) at induction of anaesthesia on post tonsillectomy morbidities. In this prospective randomized double blind study, sixty children of age between 8-12 years, ASA I &amp; II undergoing tonsillectomy under general anaesthesia were randomly assigned into two equal groups of 30 each. They received dexamethasone IV or saline (control) following induction of anaesthesia. Both anesthetic and surgical techniques were standardized. Post operative pain was assessed by visual analogue scale (VAS). Inj. Tramadol 1mg/kg in first 6 hrs and oral paracetamol 10mg/kg in next 24 hrs were administered as rescue analgesic. Incidence of nausea, vomiting, time and quantity of first oral intake were also noted. Patients receiving dexamethasone experienced significantly less pain, nausea and vomiting than control group throughout 24 hrs. Lesser patients required rescue analgesics (23.33% vs. 46.67%) in first 6 hrs. So, it is found that, single intravenous dose of dexamethasone (0.15mg/kg) provided significant analgesia, reduced nausea, vomiting and improved quality of oral intake in paediatric patients who underwent tonsillectomy. Journal of BSA, Vol. 20, No. 1, January 2007 p.13-17

Dexamethasone reduces methotrexate biliary elimination and potentiates its hepatotoxicity in rats

Increased hepatotoxicity of methotrexate has been reported during dexamethasone therapy in humans. Despite the observed inducing effect of dexamethasone on some methotrexate transporting proteins in the liver, the kinetic aspects of this interaction have not been studied yet. Thus, the aim of the present study was to evaluate the influence of dexamethasone on the hepatic and overall pharmacokinetics of methotrexate. Pharmacokinetics of methotrexate was evaluated in rats during an in vivo steady-state clearance study after either single intravenous dose of dexamethasone or its four-day oral administration in a dose optimized for transport proteins induction. Dexamethasone oral pretreatment reduced biliary clearance of methotrexate by 53%. Although liver tissue concentration of methotrexate increased only slightly in these animals, a significant increase in liver weights produced by dexamethasone pretreatment revealed a marked increase in liver content of the drug. An evaluation of plasma liver enzyme activities measured before and after methotrexate administration demonstrated a potentiation of corticosteroid hepatotoxicity by the cytostatic. Analysis of methotrexate transporter expression in the liver showed up-regulation of Mrp2, Oatp1a4, and Oat2, and down-regulation of Mrp3. These observations comply with increased biliary excretion and reduced plasma concentrations of their endogenous substrate, conjugated bilirubin. In contrast, single intravenous bolus of dexamethasone did not influence any pharmacokinetic parameter of methotrexate. In conclusion, these results indicate that hepatocellular impairment associated with reduced biliary elimination of methotrexate, and its raised liver content may contribute to increased hepatotoxicity of the drug when co-administered with dexamethasone. Moreover, an influence of dexamethasone on protein expression of anionic drugs transporters in the liver and kidney was demonstrated.

Steroids for reduction of morbidity following tonsillectomy

Of the morbidities that follow tonsillectomy, nausea and vomiting, fever, pain and inadequate oral intake are the most commonly encountered. The incidence of postoperative nausea and vomiting (PONV) has been reported as between 40% and 85%. In children, the risk of dehydration is increased owing to the delay in oral intake of fluids in the early postoperative period. In efforts to reduce postoperative morbidity, numerous modifications and adjuncts to the surgical procedure have been suggested, including the use of steroids. Reduction in PONV, pain and early return to a normal diet were studied as separate end-points in a review of the current literature. A total of 31 studies matched our search criteria and involved paediatric and adult patient populations. Only 15 studies evaluated pain, PONV and diet. The lack of standardised surgical and anaesthetic techniques and the variations in length of follow-up, concentration of steroids administered and patient age distribution weaken the impact of the results recorded in several studies. However, two-thirds show that a single intravenous dose of dexamethasone reduces pain, although this was limited to the early postoperative period. Moreover, 15 studies confirmed a beneficial effect of dexamethasone on both PONV and early oral intake. Preoperative administration of a single dose of dexamethasone to reduce postoperative morbidity resulting from tonsillectomy is supported by several studies. Adverse events have never been reported. However, further studies are warranted to determine the optimum dose required and the effect in adult tonsillectomy patients. In addition, the data should be based on standardised surgical and anaesthetic techniques to allow reliable evaluation of the significance of all outcome measures.

Regulation of thyroid hormone availability in liver and brain by glucocorticoids

Glucocorticoids as well as thyroid hormones are essential for normal brain development. Exogenous glucocorticoids stimulate 3,3′,5-triiodothyronine (T 3) availability in circulation of birds and similar effects have been observed in sheep. Chicken data indicate that glucocorticoid administration also stimulates thyroid hormone metabolism in brain but the effects on local thyroid hormone concentrations are not known. Therefore, the current study: (1) determined local thyroid hormone availability in separate brain areas of 18-day-old embryonic chickens (E18) after injection of dexamethasone (DEX), and (2) investigated the impact on the thyroid hormone metabolic pathways in these brain parts and compared the results with the hepatic situation. For this, E18 chicken embryos were treated with a single intravenous dose of DEX (25 μg). Despite the decreased 3,5,3′,5-tetraiodothyronine (T 4) availability in the liver of the DEX treated embryos, the T 3 content was strongly increased, parallel to the plasma T 3 surge. This T 3 surge was primarily related to a fall in hepatic T 3 breakdown through a downregulation of the type III deiodinase (D3). The sulfation pathway in liver seems not to be affected by DEX. In all brain parts, DEX affects the T 3 production capacity by upregulation of the type II deiodinase (D2). This enables the brain to compensate for the decrease in T 4 availability, although the T 3 concentrations are not consistently increased like in plasma and liver. This observation points to the existence of a fine-tuning mechanism in brain that enables the brain to keep the T 3 concentrations within narrow limits.

Steroids for improving recovery following tonsillectomy in children.

Tonsillectomy continues to be one of the most common surgical procedures performed worldwide. Despite advances in anesthetic and surgical techniques, post-tonsillectomy morbidity remains a significant clinical problem. To assess the clinical efficacy of a single intra-operative dose of dexamethasone in reducing post-tonsillectomy morbidity. We searched the Cochrane Controlled Trials Register (Issue 1, 2002), MEDLINE (from 1966 - February 2002), EMBASE (from 1974 - February 2002) and reference lists of relevant articles. We contacted leading experts for information on any relevant unpublished data. Randomized, double-blind, placebo-controlled trials of a single dose of intravenous, intra-operative corticosteroid for pediatric patients (age < 18 years) who underwent tonsillectomy or adenotonsillectomy were included. Data regarding the primary outcome measures and measurement tools were extracted by the first author from the published studies. Data regarding study design, patient ages, procedures performed, dose of corticosteroid and method of delivery, as well as methodologic quality were also recorded by the first author. When data were missing from the original publications, the authors were contacted for more information. Data analysis was performed with a random effects model, using the RevMan 4.1 software developed by the Cochrane Collaboration. Children receiving a single intra-operative dose of dexamethasone (dose range = 0.15 to 1.0 mg/kg; maximum dose range = 8 to 25 mg) were two times less likely to vomit in the first 24 hours than children receiving placebo (RR = 0.54, CI95 = 0.42, 0.69; p < 0.00001). Routine use in four children would be expected to result in one less patient experiencing post-tonsillectomy emesis (RD = -0.25, CI95 = -0.37, -0.13; p = 0.00004). Additionally, children receiving dexamethasone were more likely to advance to a soft/solid diet on post-tonsillectomy day 1 (RR = 1.69, CI95 = 1.02, 2.79; p = 0.04) than those receiving placebo. Due to missing data and varied outcome measurement tools, pain could not be meaningfully analyzed as a distinct outcome measure. The evidence suggests that a single intravenous dose of dexamethasone is an effective, relatively safe and inexpensive treatment for reducing morbidity from pediatric tonsillectomy. No adverse events attributable to dexamethasone were reported in these trials. Additionally, in our 10-year experience of routine use of a single intravenous dose of dexamethasone during pediatric tonsillectomy, there have been no attributable, adverse events. Lastly, we found no reports in the literature of complications from use of a single intravenous dose of corticosteroid during pediatric tonsillectomy.

A Comparison of Two Prophylactic Regimens for Hypersensitivity Reactions to Paclitaxel

Objective. The aim of this study was to compare the rates of hypersensitivity reactions to paclitaxel with the conventional prophylactic regimen of two doses of oral corticosteroids and a modified regimen of a single dose of intravenous corticosteroid.Methods. This was a retrospective historical cohort study assessing the rates of hypersensitivity reactions in patients receiving paclitaxel for ovarian or primary peritoneal carcinoma at the Hamilton Regional Cancer Centre from 1996 to 2000. Until 1998, all patients received the conventional prophylactic regimen consisting of two doses of oral dexamethasone (20 mg), 12 and 6 h prior to paclitaxel. From 1998 to the present, patients received a single dose of intravenous dexamethasone (20 mg), 30 min prior to paclitaxel. All patients also received an H1 and H2 blocker intravenously prior to paclitaxel administration. The analysis was corrected for potential covariates such as dose of paclitaxel and rate of infusion. The primary outcome measure was the rate of hypersensitivity reactions as defined by the National Cancer Institute of Canada–Clinical Trials Group. The Yates-corrected χ2 test was used to compare the rates of these reactions, and a logistic regression analysis was used to determine whether any of the covariates were significant factors in these reactions.Results. One hundred seven patients received the conventional corticosteroid prophylaxis prior to paclitaxel, and 110 received the single-dose intravenous corticosteroid prophylaxis. Of the 107 patients in the conventional prophylaxis group, 8 had a hypersensitivity reaction (7.5%), and only 1 of these was severe (0.9%). In contrast, of the 110 patients in the single-dose IV corticosteroid group, 19 had a hypersensitivity reaction (17.3%), and 8 of these were severe (7.3%). The difference in hypersensitivity reaction rates was significant (χ2, P = 0.047). In the logistic regression analysis, the only significant factor related to hypersensitivity reactions was the type of prophylactic steroid regimen.Conclusions. In this series, the single-dose intravenous corticosteroid prophylactic regimen appeared to be associated with a higher rate of hypersensitivity reactions to paclitaxel than the conventional two-dose oral corticosteroid regimen.

Prophylaxis for paclitaxel hypersensitivity reactions.

To evaluate clinical literature supporting the prophylactic use of single-dose intravenous dexamethasone to prevent hypersensitivity reactions (HSRs) to paclitaxel infusion. Clinical literature accessed through MEDLINE (from 1986 to 2000). Prophylaxis for paclitaxel-related HSRs generally includes repeated dexamethasone doses beginning 12 hours before paclitaxel, and administration of diphenhydramine plus a histamine2-receptor antagonist 30 minutes before infusion of paclitaxel. Singe-dose intravenous dexamethasone administered with ancillary medications 30 minutes before infusion of paclitaxel has been used to prevent regimen-related HSRs. Single-dose intravenous dexamethasone can be used in combination with appropriate ancillary medications to prevent paclitaxel-related HSRs.

Perioperative intravenous steroid treatment and tonsillectomy.

agnosis, and surgical and anesthetic technique. The anesthetic techniques varied from study to study. All used a single intravenous dose of dexamethasone, administered after anesthetic induction but prior to the surgical procedure, with some variation in dose. These studies were done on otherwise healthy individuals without chronic medical problems and in most cases specifically excluded patients with ulcers, diabetes, and steroid-dependent asthma or other conditions. PRO

Characterization of dexamethasone-induced reactivation of latent bovine herpesvirus 1.

Synchronous reactivation of bovine herpesvirus type 1 in all latently infected rabbits was achieved following a single intravenous dose of dexamethasone. Reactivated latent virus was first present in ocular secretions between 48 and 72 h post-dexamethasone treatment (PT). Cell-free infectious virus, viral-antigen-containing neurons, and pathologic changes were detectable in trigeminal ganglia (TG) by 48 h PT. A shift from the viral transcriptional pattern characteristic of the latent state (latency-related RNA [LR RNA]) to one typical of that seen during acute infection was detected in a small number of neurons in latently infected TG between 15 and 18 h PT, with viral DNA first detectable by in situ hybridization at 18 to 21 h PT. The number of LR RNA-containing neurons in latently infected TG decreased significantly at 24 and 48 h PT but returned to near-normal levels by 72 h PT. Correlation of this decrease with viral reactivation suggests that altered regulation of LR RNA transcription is a significant event in the process of viral reactivation.