Dexamethasone Reduces the Incidence of Postoperative Nausea and Vomiting in Children Undergoing Endoscopic Adenoidectomy under General Anesthesia Without Increasing the Risk of Postoperative Hemorrhage

Abstract

BackgroundPostoperative nausea and vomiting (PONV) is a common complication of pediatric anesthesia, but the overall incidence of PONV in patients undergoing adenoidectomy is unknown. The aim of this controlled study was to compare the effect of dexamethasone administration with placebo to reduce PONV in children undergoing endoscopic adenoidectomy under general anesthesia.Material/MethodsA randomized placebo-controlled study included 118 pediatric patients who underwent elective endoscopic adenoidectomy under general anesthesia. A dexamethasone-treated (0.15 mg/kg) group (Group D) (n=56) and a placebo group (Group C) (n=62) were randomly assigned. The incidence of nausea and vomiting was recorded on the day of surgery. Postoperative nausea was assessed according to illustrated Baxter Animated Retching Faces (BARF) scale. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale (scores between 0–10) was used to assess pain. Follow-up was performed on the 14th postoperative day by a telephone call.ResultsOverall prevalence of postoperative nausea was 25% (30/118) and postoperative vomiting was 14% (17/118). In the first 24 hours following surgery, in Group D, the incidence of nausea and vomiting was 13% and 7%, respectively; in Group C, without pharmacological prophylaxis, the incidence of postoperative nausea and vomiting was 37%, and 21%, respectively.ConclusionsA prospective controlled study in children undergoing endoscopic adenoidectomy under general anesthesia showed that dexamethasone (0.15 mg/kg) significantly reduced the incidence of PONV without increasing the risk of postoperative hemorrhage. Dexamethasone is a safe method for the prevention of PONV that may be recommended in pediatric anesthesiology.

Endoscopic adenoidectomy: a systematic analysis of outcomes and complications in 1006 patients

“…All patients underwent intraoperative and 5-day post-surgical antibiotic prophylaxis with oral amoxicillin and clavulanic acid (70 mg amoxicillin/10 mg clavulanate/kg in three daily doses) or oral clarithromycin (15 mg/kg in two daily doses, in patients with known beta-lactam or clavulanate allergies). Furthermore, intraoperative steroid prophylaxis with dexamethasone 0.15 mg/kg was given in all children to reduce postoperative nausea and vomiting 16 .…”

It was not clear

“…Earlier lots of studies have shown that postoperative nausea and vomiting(PONV) is one of the most common adverse events after laparoscopic surgery with a reported incidence of 40-75%, which may delay postoperative recovery and discharge [2,3]. In addition, PONV is the leading cause of discontinuation of intravenous patient-controlled analgesia (PCA), leading to decrease in the patient satisfaction and increase in the adverse effects (including the postoperative catheter-related bladder discomfort) [3,4]. So, PONV in patients scheduled for laparoscopic surgery has been prevented and treated with a variety of antiemetics [4].…”

Dexamethasone for the prevention of postoperative nausea and vomiting in children undergoing non-cardiac surgery: a systematic review and meta-analysis

“…Six studies [8,10,13,15,17,19] reported the incidence of POV in the dexamethasone and placebo groups. In the Madan study [13], dexamethasone was compared at three different doses (0.25, 0.5, 1.0 mg/kg), and we selected all groups as dexamethasone groups for meta-analysis because dexamethasone in other studies was administered at doses ranging from 0.15 mg/kg to 1.0 mg/kg.…”

“…Four studies [8,10,15,19] reported the incidence of PON between the dexamethasone and placebo groups. The results showed that the incidence of PON in the dexamethasone group was significantly lower than that in the placebo group (RR 0.40, 95% CI 0.27-0.59, P<0.01; NNT =4.40; n =415; Figure 3).…”

“…Several studies have reported that preoperative dexamethasone can effectively prevent PONV after tonsillectomy [8,9]. In another RCT, patients with dexamethasone intervention had a significantly lower incidence of nausea and vomiting within 24 hours than patients who received placebo [10]. A meta-analysis reported that dexamethasone in combination with serotonin type 3 (5-HT3) receptor antagonists in children undergoing strabismus surgery is recommended [11].…”