Re: Dexamethasone and risk of PONV and postoperative bleeding after tonsillectomy in children

Post-operative nausea and vomiting following paediatric day-case tonsillectomy: audit of the Epsom protocol

“…Some of the children involved had multiple episodes of bleeding, and it is possible that these patients had an undiagnosed coagulation disorder such as von Willebrand's disease. 21 Where routine use of an antiemetic has been adopted, and use of opiate analgesia and nitrous oxide anaesthesia continued, a modest improvement in post-operative nausea and vomiting has been reported (from 27 to 11 per cent). However, this does not match the low level observed in our current audit of the Epsom protocol.…”

“…This study raised many methodological and analytical concerns, and was abandoned because of an unacceptably high bleeding rate (11 per cent). Some of the children involved had multiple episodes of bleeding, and it is possible that these patients had an undiagnosed coagulation disorder such as von Willebrand's disease 21 …”

The Effect of a Postoperative Course of Oral Prednisone on Postoperative Morbidity following Childhood Tonsillectomy

“…5 Czarnetzki et al 6 examined different dosages of intraoperative dexamethasone and showed an increased bleeding rate among their study groups such that they discontinued the study. However, there has been discussion about the design of this trial 7,8 ; subsequently, 2 research groups with larger study populations who had identical steroid dosing intraoperatively published their lower rates of bleeding. 8,9 As these rates were similar to previously reported standard rates of postoperative hemorrhage and lower than those found in the other study, they concluded that a single dose of intraoperative steroid does not have an effect on postoperative hemorrhage.…”

Betamethasone in hernia surgery: A randomized controlled trial

“…One publication reported an increased risk for bleeding after paediatric tonsillectomy and dexamethasone (Czarnetzki et al., ). However, that study was criticized for bad design and a very high overall incidence of bleeding (Robb, ).…”