title: The effect of single low-dose dexamethasone on vomiting during awake craniotomy.
abstract: Intraoperative vomiting leads to serious respiratory complications that could influence the surgical decision-making process for awake craniotomy. However, the use of antiemetics is still limited in Japan. The aim of this study was to investigate the effect of prophylactically administered single low-dose dexamethasone on the incidence of vomiting during awake craniotomy. The frequency of hyperglycemia was also examined.
  
  
  
  We conducted a retrospective case review of awake craniotomy for glioma resection between 2012 and 2015.
  
  
  
  Of the 124 patients, 91 were included in the analysis. Dexamethasone was not used in 43 patients and the 48 remaining patients received an intravenous bolus of 4.95 mg dexamethasone at anesthetic induction. Because of stable operating conditions, no one required conscious sedation throughout functional mapping and tumor resection. Although dexamethasone pretreatment reduced the incidence of intraoperative vomiting (P = 0.027), the number of patients who complained of nausea was comparable (P = 0.969). No adverse events related to vomiting occurred intraoperatively. Baseline blood glucose concentration did not differ between each group (P = 0.143), but the samples withdrawn before emergence (P = 0.018), during the awake period (P < 0.0001) and at the end of surgery (P < 0.0001) showed significantly higher glucose levels in the dexamethasone group. Impaired wound healing was not observed in either group.
  
  
  
  A single low-dose of dexamethasone prevents intraoperative vomiting for awake craniotomy cases. However, as even a small dose of dexamethasone increases the risk for hyperglycemia, antiemetic prophylaxis with dexamethasone should be administered after careful consideration. Monitoring of perioperative blood glucose concentration is also necessary.
authors: Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. macaroon@nifty.com.
authors: Kotoe
authors: K
authors: Kamata
authors: Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors: Nobutada
authors: N
authors: Morioka
authors: Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.|Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
authors: Takashi
authors: T
authors: Maruyama
authors: Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors: Noriaki
authors: N
authors: Komayama
authors: Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.|Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
authors: Masayuki
authors: M
authors: Nitta
authors: Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.|Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
authors: Yoshihiro
authors: Y
authors: Muragaki
authors: Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
authors: Takakazu
authors: T
authors: Kawamata
authors: Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors: Makoto
authors: M
authors: Ozaki
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000008:administration & dosage* / Q000627:therapeutic use; D003399:Craniotomy / Q000379:methods*; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000517:prevention & control; D012189:Retrospective Studies; D014839:Vomiting / Q000517:prevention & control*; D014851:Wakefulness
chemical_list: D000932:Antiemetics; D003907:Dexamethasone
keywords: Awake craniotomy; Dexamethasone; Intraoperative complications; Vomiting