The Effect of Intravenous Dexamethasone in Pediatric Adenotonsillectomy

April, Max M.; Callan, Noreen D.; Nowak, Donna M.; Hausdorff, Mark

doi:10.1001/archotol.1996.01890140007003

Cited by 91 publications

(70 citation statements)

References 8 publications

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“…It is important to reduce postsurgical bleeding and to minimize postsurgical pain [7,8]. Administration of steroids to patients undergoing tonsillectomy or adenoidectomy has been found to reduce postsurgical nausea, vomiting and pain, although it may also increase postsurgical bleeding [9,11]. Similarly, the ability of short acting intravenous anesthetics plus steroids to prevent postsurgical nausea and vomiting has been assessed in children undergoing tonsillectomy or adenoidectomy [4], but less is known about the association between anesthetic agents and bleeding after tonsillectomy.…”

Section: Discussionmentioning

confidence: 99%

Analysis of prognostic factors for postoperative bleeding after tonsillectomy

Kim

Lee

Kim

et al. 2011

Eur Arch Otorhinolaryngol

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Postoperative bleeding is the most frequent surgical complication after tonsillectomy and may be associated with increased mortality rate. We have, therefore, analyzed factors associated with and prognostic for bleeding after tonsillectomy. The 2,254 patients who underwent tonsillectomy under general anesthesia at our institution from January 2005 to December 2009 were divided into bleeding and non-bleeding groups, and their demographic and clinical characteristics were compared. Age, administration of steroid immediately after general anesthesia, absence of administration of non-steroidal anti-inflammatory drugs, and the surgeon's experience were significantly associated with bleeding. In contrast, gender, chief complaints, performance of associated surgery, and type of anesthetic were not associated with postoperative bleeding. Hemorrhage after tonsillectomy was associated with the administration of steroids and with the non-administration of non-steroidal anti-inflammatory drugs.

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Section: Discussionmentioning

confidence: 99%

Analysis of prognostic factors for postoperative bleeding after tonsillectomy

Kim

Lee

Kim

et al. 2011

Eur Arch Otorhinolaryngol

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“…PONV may necessitate overnight hospital admission for intravenous hydration and pain control, and leads to increased costs and decreased patient satisfaction [18,19,20]. A single dose of intraoperative dexamethasone has been clearly demonstrated to have potent antiemetic effects in the perioperative setting [5,8,9,11,12,13,14,21,22,23]. The aforementioned Cochrane study demonstrated that, compared with placebo, children receiving dexamethasone were less likely to vomit in the first 24 h (relative risk, RR, 0.54; 95% confidence interval, CI, 0.42-0.69) and were more likely to advance to a soft or solid diet on postoperative day 1 (RR, 1.69; 95% CI, 1.02-2.79) [5].…”

Section: Why Steroids?mentioning

confidence: 99%

“…In 2008, prior to the existence of any steroid controversy, there was a wealth of literature in favor of giving intraoperative steroids during pediatric tonsillectomy to prevent postoperative nausea and vomiting [6,7,8,9,10,11,12,13,14]. Few studies existed with demonstrative data suggesting adverse consequences of perioperative dexamethasone administration.…”

Section: Introductionmentioning

confidence: 99%

The Steroid Controversy: Where Are We?

Keller

Brigger

2013

ORL

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Dexamethasone is widely administered to children during elective tonsillectomy to reduce the rate of postoperative nausea and vomiting, as well as decrease postoperative use of pain medications. Over the past two decades, there has been a wealth of literature advocating the practice that has led to endorsement by a variety of anesthesia and otolaryngology professional associations. However, the publication of a trial that was halted due to a potential dose-dependent association between postoperative hemorrhage and dexamethasone raised significant scrutiny regarding the practice in 2008. As a result, significant re-evaluation of existing data as well as the development and execution of additional trials have been pursued in recent years. Ultimately, the body of evidence that currently exists appears to support the concept that a single dose of perioperative dexamethasone is not associated with undue risk. A decision to withdraw dexamethasone from use in pediatric tonsillectomy needs to be weighed against the potential of causing increased postoperative nausea, vomiting, pain, and resultant hospital readmission. At this point, surgeons and anesthesiologists should feel comfortable giving perioperative dexamethasone but must remain vigilant for bleeding complications.

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“…There have been studies which show decreasing incidence of vomiting after electrodissection tonsillectomy shortening the first oral intake time and increasing quality of oral intake in pediatric age group [10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%