The Effect of Preoperative Dexamethasone on the Immediate and Delayed Postoperative Morbidity in Children Undergoing Adenotonsillectomy

Pappas, Ana Lucia; Sukhani, Radha; Hotaling, Andrew J.; Mikat-Stevens, Marianna; Javorski, Joseph J.; Donzelli, Joseph; Shenoy, Kalavathi

doi:10.1213/00000539-199807000-00013

Cited by 120 publications

(84 citation statements)

References 19 publications

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“…Similar prosteroid results were reported by Splinter and Roberts 2 and Pappas et al, 3 yet there was a 10-fold difference between the 2 studies in the amount of medication used. This makes me question whether factors other than the effects of the steroids were being measured.…”

Section: Do Steroids Really Work?supporting

confidence: 83%

Tonsillectomy and Postoperative Vomiting

Shott¹

2001

Arch Otolaryngol Head Neck Surg

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Section: Do Steroids Really Work?supporting

confidence: 83%

Tonsillectomy and Postoperative Vomiting

Shott¹

2001

Arch Otolaryngol Head Neck Surg

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“…The incidence of vomiting, need for rescue anti emetic treatment, and analgesic requirements were not different before hospital discharge, but during the 24-h period after that, fewer patients in the steroid group experienced vomiting (48 vs 88%; P < 0.5). [7]…”

Section: Discussionmentioning

confidence: 99%

A prospective study to compare the effects of pre,intra and post operative steroid (dexamethasone sodium phosphate) on post tonsillectomy morbidity

Thimmasettaiah¹,

Chandrappa²

2012

Journal of Pharmacology and Pharmacotherapeutics

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Objective:To determine the effectiveness of dexamethasone on post tonsillectomy morbidities in patients with chronic tonsillitis.Materials and Methods:In this randomized double-blind study, 100 patients who underwent tonsillectomy were enrolled and were randomly allocated into control or dexamethasone group (pre operative, intra operative and post operative groups). Patients were assessed for pain nausea, vomiting and oral intake in the post operative period at 24 h.Results:Patients treated with dexamethasone particularly in the pre and intra operative groups (Group B, Group C) showed a general trend towards lower pain score than post operative group (Group D). The scores were about 1.72±0.84 and 2.20±1.19 in Groups B and C respectively, and 2.64±0.99 in Group D. Overall pain score was found to be more in the control Group A about 4.84±1.21 at 6 h post operatively and showed similar trend for next 24 h. Total number of patients with nausea was significantly high about 84% in control group compared to dexamethasone groups (Group B, C and D) about 20%, 8% and 24% respectively and also incidence of vomiting episodes showed a similar trend. Oral intake was significantly delayed in control group (6.16 ±1.52), P < 0.001 than dexamethasone group. Pre operative and intra operative groups showed early intake (3.68±0.68) and (3.60±1.12) respectively than the postoperative group (5.08±0.95).Conclusions:A single intravenous dose of dexamethasone, given following induction of anaesthesia and at the time of surgery, provided prolonged analgesia, reduced nausea and vomiting and resulted in earlier oral intake.

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“…This dates to the important articles by Davidson et al 1 and Lopez et al 2 The incidence was found to be 0.8% in the study of Davidson et al and 1.2% in the work of Lopez et al, substantially higher than the usual quoted 0.1% to 0.2% in adult patients. Both articles used a follow-up questionnaire at specific time points to determine the incidence of awareness.…”

mentioning

confidence: 82%

“…Multiple previous studies have demonstrated the benefit of dexamethasone in reducing PONV and pain using doses ranging from 0.5 to 1 mg/kg. 1,2 If there is any question concerning dexamethasone, it is what is the lowest possible dose that will be effective.…”

Section: Commentmentioning

confidence: 99%

Intraoperative Awareness During Pediatric Anesthesia

&NA;

2009

Survey of Anesthesiology

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A long neglected area, the subject of awareness and recall under anesthesia in the pediatric population, has seen increased interest of late. This dates to the important articles by Davidson et al 1 and Lopez et al. 2 The incidence was found to be 0.8% in the study of Davidson et al and 1.2% in the work of Lopez et al, substantially higher than the usual quoted 0.1% to 0.2% in adult patients. Both articles used a follow-up questionnaire at specific time points to determine the incidence of awareness. This method, despite the greatest rigor of the investigators, is fraught with the possibility that what a child recalls is not actually an intraoperative event. Davidson et al 3 followed up their work with a recent study using the Brice method. This method exposes the child to a specific intraoperative sound using headphones and then uses postoperative questioning to determine if the child can recall the sound. The method is simple and elegant, overcoming some of the inherent difficulties in assessing pediatric awareness. The investigation, however, suffered from the fact that the attending anesthesiologist knew his/her patient would later be questioned about intraoperative sounds. One also cannot ignore the possibility of a deeper level of anesthesia being unintentionally administered to the study patients. This might have accounted for the incidence of recall being zero, a sharp difference from the work of Davidson et al 1 in 2005.The work of Blussé van Oud-Alblas et al shows an incidence of 0.6% using their most strict criteria. A more liberal definition of awareness results in an incidence of 1.5%. Their methods were also structured questionnaires given at specific time points, taking great care not to use leading or suggestive questions. There is now a growing body of evidence that the incidence of pediatric awareness and recall is higher than in adults. We are also gaining insight into the nature of awareness. Pediatric patients seem to recall tactile and auditory sensations. Interestingly, the pediatric brain may be more prone to a dreamlike state under anesthesia. In the group of children who were not deemed to have awareness, fully 9% had recall of dreaming under anesthesia. Two of 6 children with recall also reported dreaming under anesthesia. Much less often do children report pain, anxiety, and paralysis even when muscle relaxants are used. The experience seems to be regarded by children as more curious than stressful and serious psychological effects are rare. Although the nature of awareness is becoming clearer, identifiable risk factors are proving elusive. If identifiable risk factors are absent, perhaps there is a test that might reveal the likelihood of intraoperative awareness. A weakness of the study is the lack of bispectral index (BIS) monitoring. Because BIS is the only widely available monitor purporting to reduce the incidence of awareness, it would be interesting to know the BIS levels at the time points during surgery when the children reported awareness.All children who were aware had conv...

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The Effect of Preoperative Dexamethasone on the Immediate and Delayed Postoperative Morbidity in Children Undergoing Adenotonsillectomy

Cited by 120 publications

References 19 publications

Tonsillectomy and Postoperative Vomiting

Tonsillectomy and Postoperative Vomiting

A prospective study to compare the effects of pre,intra and post operative steroid (dexamethasone sodium phosphate) on post tonsillectomy morbidity

Intraoperative Awareness During Pediatric Anesthesia

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