Dexamethasone is a commonly used drug in anesthesia and surgery. The purported beneficial effects are diverse, especially for the prophylaxis and treatment of postoperative nausea and vomiting, but the optimal dose and the clinical implications of potential side effects require an updated summary of all available evidence.

This article reviews major trials and other studies of perioperative dexamethasone in adult noncardiac surgery, focusing on patient selection, optimal dose, and safety. We briefly consider its mode(s) of action and central role in the management of postoperative nausea and vomiting before providing updates on the benefits of dexamethasone for postoperative pain, quality of recovery, fatigue, sleep disturbance and mood, major complications and death, surgical site infection, hyperglycemia and diabetes control, and perioperative neurocognitive disorders, and conclude with a consideration of the optimal dexamethasone dose. We will not consider its use...

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