Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis

Abstract

Summary In children undergoing tonsillectomy, dexamethasone is recommended to reduce the risk of postoperative nausea and vomiting while non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain relief. We aimed to determine whether children who receive dexamethasone or dexamethasone with NSAID are more likely to experience haemorrhage post-tonsillectomy. Randomized and non-randomized studies in which children undergoing tonsillectomy received dexamethasone or dexamethasone and NSAID were sought within bibliographic databases and selected tertiary sources. The risk of bias assessment and evaluation of haemorrhage rate data collection and reporting were assessed using the Cochrane Risk of Bias Tool and McHarm tool. Synthesis methods comprised pooled estimate of the effect of dexamethasone on the risk of haemorrhage rate using the Peto odds ratio (OR) method. The pooled estimate for haemorrhage rate in children who received dexamethasone was 6.2%, OR 1.41 (95% confidence interval 0.89-2.25, P=0.15). There was risk of bias and inconsistent data collection and reporting rates of haemorrhage in many of the included studies. Clinical heterogeneity was observed between studies. The pooled analysis did not demonstrate a statistically significant increase in the risk of post-tonsillectomy haemorrhage with dexamethasone with/without NSAID use in children. However, the majority of the included studies were not designed to investigate this endpoint, and thus large studies which are specifically designed to collect data on haemorrhage rate are needed.

Gender-specific risk factors in post-tonsillectomy hemorrhage

“…This may be caused by the more frequent occurrence of PTAs in men, and the subsequently increased rate of uvula edema. However, upto-date studies and meta-analyses have failed to show an increased risk of PTH after dexamethasone application [46,47].…”

If nothing happens, is everything all right? Distinguishing genuine reassurance from a false sense of security

“…For example, a recent systematic review of harm with dexamethasone deployed the Cochrane risk-of-bias tool and the McHarm tool in parallel. 8 A further important consideration in metaanalyses of adverse events is the extent of missing information. In the study by Gillies and colleagues, data on diarrhea were available from only 10 of 28 eligible amoxicillin trials.…”

Post-tonsillectomy bleeding: Our 10-year experience

“…Ameliyat sırası kortikosteroid enjeksiyonu ise, öneriler doğrul-tusunda özellikle ameliyat sonrası bulantı ve kusmanın engellenmesi ve hava yolu ödeminin azaltılarak larengospazmların önüne geçilmesi amacıyla rutin bir şekilde tonsillektomi sırasında uygulanmaktadır. [3,12] Kortikosteroidlerin ameliyat sonrası kanamayı artırmadığı konu ile ilgili bir metaanalizde gösterilmiştir. [28] Tonsillektomi sırasında rutin antibiyotik profilaksisi yapılma-ması gerektiği belirtilmişse de ameliyat sonrası dönemde antibiyotik profilaksisi konusunda farklı görüşler vardır.…”

“…[1,2] Tonsillektomi ve adenotonsillektomi sonrasında en sık bulantı, kusma, solunumsal sorunlar, oral alım kısıtlılığı, dehidratasyon, ateş yüksekliği ve kanama olmak üzere bazı komplikasyonlar görülebilir. [2,3] Ameliyat sonrası kanama, en sık karşılaşılan ve en ciddi komplikasyonlarından-dır. [1,[3][4][5] Kanama komplikasyonu erken veya geç dönemde görülebilir.…”

“…[2,3] Ameliyat sonrası kanama, en sık karşılaşılan ve en ciddi komplikasyonlarından-dır. [1,[3][4][5] Kanama komplikasyonu erken veya geç dönemde görülebilir. İlk 24 saat içinde görülen kanamalar primer kanama olarak sınıflandı-rılırken, daha sonra ortaya çıkan kanamalar sekonder kanama olarak adlandırılır.…”