Dexamethasone Dosing for Donor Nephrectomy
For healthy adults undergoing donor nephrectomy, administer a single perioperative dose of 8-10 mg IV dexamethasone to reduce postoperative nausea, vomiting, and opioid requirements without increasing surgical complications.
Recommended Dosing Strategy
The optimal dose is 8-14 mg IV dexamethasone given as a single perioperative injection. 1 This higher dose range (8-14 mg) significantly reduces postoperative nausea and vomiting by 28% compared to no dexamethasone, while lower doses of 4-6 mg do not provide the same benefit. 1
Specific Dosing Recommendations
- Standard dose: 8-10 mg IV dexamethasone administered perioperatively 1
- Acceptable range: 8-14 mg IV as a single dose 1
- Avoid lower doses: 4-6 mg doses are ineffective for preventing postoperative nausea and vomiting in this population 1
Clinical Benefits
The higher dose (8-14 mg) provides multiple advantages:
- Reduces total opioid consumption by 29% in the first 24 hours postoperatively compared to no dexamethasone 1
- Decreases antiemetic requirements significantly in the immediate postoperative period 1
- No increase in surgical complications or prolonged hospital stays when compared to controls 1
- Independent protective factor against postoperative nausea and vomiting in multivariate analysis 1
Administration Timing and Route
- Give as a single perioperative injection (typically at induction or during surgery) 1
- IV and oral bioavailability are equivalent (1:1 conversion), so 8 mg IV = 8 mg oral 2
- Administer IV slowly over several minutes to avoid perineal burning sensation 3
Important Clinical Considerations
This is a single-dose strategy - dexamethasone for donor nephrectomy differs fundamentally from multi-day regimens used in chemotherapy-induced nausea (which use 12 mg on day 1, then 8 mg on days 2-4). 2 The surgical context requires only one perioperative dose. 1
Safety profile is excellent - no increased risk of wound complications, infections, or hyperglycemia has been demonstrated with this single-dose approach in the donor nephrectomy population. 1
Avoid underdosing - the most common pitfall is using 4-6 mg doses, which are ineffective for preventing postoperative nausea and vomiting in laparoscopic donor nephrectomy. 1 The evidence clearly demonstrates that 8 mg or higher is necessary for clinical benefit. 1