Dexamethasone and Risk of Nausea and Vomiting and Postoperative Bleeding After Tonsillectomy in Children

Czarnetzki, Christoph; Elia, Nadia; Lysakowski, Christopher; Dumont, Lionel; Landis, Basile Nicolas; Giger, Roland; Dulguerov, Pavel; Desmeules, Jules Alexandre; Tramèr, Martin R.

doi:10.1001/jama.2008.794

Cited by 192 publications

(216 citation statements)

References 45 publications

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“…The wide variation in dexamethasone use may relate to a concern of increased bleeding risk as reported in 1 trial. 27 However, the AAO-HNS guidelines, 2 and a subsequent trial, 28 have concluded that there is no clinically important increased risk. The variation in revisits may indicate differences in processes of care during the index hospitalization (eg, surgical technique, 25 anesthesia, pain management, discharge education) or postdischarge (eg, follow-up care, pain management).…”

Section: Figurementioning

confidence: 99%

Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children’s Hospitals

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Tonsillectomy is one of the most commonly performed surgeries in children and is one of the most cumulatively expensive conditions in pediatric hospital care. Little is known about how the quality of tonsillectomy care varies across hospitals. WHAT THIS STUDY ADDS:In a large cohort of low-risk children undergoing same-day tonsillectomy, there was substantial variation in quality measures of process, dexamethasone and antibiotic use, and outcome, revisits to the hospital within the first 30 days after surgery. abstract OBJECTIVE: To describe the quality of care for routine tonsillectomy at US children' s hospitals. METHODS:We conducted a retrospective cohort study of low-risk children undergoing same-day tonsillectomy between 2004 and 2010 at 36 US children' s hospitals that submit data to the Pediatric Health Information System Database. We assessed quality of care by measuring evidence-based processes suggested by national guidelines, perioperative dexamethasone and no antibiotic use, and outcomes, 30-day tonsillectomy-related revisits to hospital. RESULTS:Of 139 715 children who underwent same-day tonsillectomy, 10 868 (7.8%) had a 30-day revisit to hospital. There was significant variability in the administration of dexamethasone (median 76.2%, range 0.3%-98.8%) and antibiotics (median 16.3%, range 2.7%-92.6%) across hospitals. The most common reasons for revisits were bleeding (3.0%) and vomiting and dehydration (2.2%). Older age (10-18 vs 1-3 years) was associated with a greater standardized risk of revisits for bleeding and a lower standardized risk of revisits for vomiting and dehydration. After standardizing for differences in patients and year of surgery, there was significant variability (P , .001) across hospitals in total revisits (median 7.8%, range 3.0%-12.6%), revisits for bleeding (median 3.0%, range 1.0%-8.8%), and revisits for vomiting and dehydration (median 1.9%, range 0.3%-4.4%).CONCLUSIONS: Substantial variation exists in the quality of care for routine tonsillectomy across US children' s hospitals as measured by perioperative dexamethasone and antibiotic use and revisits to hospital. These data on evidence-based processes and relevant patient outcomes should be useful for hospitals' tonsillectomy quality improvement efforts. Pediatrics 2014;133:280-288

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Section: Figurementioning

confidence: 99%

Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children’s Hospitals

et al. 2014

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“…Intrathecal clonidine given in doses from 15 to 150 mcg combined with intrathecal local anaesthetic, significantly prolonged the time to two segment block regression but did not affect the rate of onset of a complete block (Elia et al, 2008 Level I). Intrathecal clonidine also prolonged the time to first analgesic request (median 101 min, range 35 to 310 min) and duration of motor block but in a non-dose-dependent manner; intraoperative pain was reduced but hypotension was more frequent ( Intrathecal clonidine 100 mcg added to 500 mcg intrathecal morphine resulted in better pain relief and faster time to extubation after cardiac surgery compared with intrathecal morphine alone (Nader et al, 2009 Level II).…”

Section: Neuraxialmentioning

confidence: 96%

“…There was a reduced risk of postoperative nausea and vomiting and reduced use of ibuprofen but also an increased risk of bleeding (Czarnetzki et al, 2008 Level II).…”

Section: Diclofenac (Romsing Et Al 2000 Level Ii; Schmidt Et Al 2001mentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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“…publiaient un article dans le Journal of the American Medical Association qui a suscité une recrudescence des inquiétudes concernant le risque de saignement postopératoire chez les enfants subissant une amygdalectomie et ayant reçu de la dexaméthasone. 18 Ces inquiétudes sont apparues à l'issue d'un projet de recherche dont l'objectif initial était de rechercher la dose optimale de dexaméthasone à administrer afin de prévenir les NVPO. L'étude a été interrompue prématurément en raison de l'apparente incidence accrue de saignements postopératoires, plus abondants que prévu.…”

Section: Innocuité Deunclassified

“…18 This arose from an investigation initially designed as a dose-finding study to determine the optimal amount of dexamethasone to prevent PONV. The study was terminated prematurely, as there appeared to be a higher than expected incidence of postoperative bleeding.…”

mentioning

confidence: 99%

Safety of perioperative dexamethasone administration in children: time for reflection?

Yee

Cox

2013

Can J Anesth/J Can Anesth

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Dexamethasone and Risk of Nausea and Vomiting and Postoperative Bleeding After Tonsillectomy in Children

Abstract: clinicaltrials.gov Identifier: NCT00403806.

Cited by 192 publications

References 45 publications

Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children’s Hospitals

Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children’s Hospitals

Safety of opioid patch initiation in Australian residential aged care

Safety of perioperative dexamethasone administration in children: time for reflection?

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