Perioperative Dexamethasone Administration and Risk of Bleeding Following Tonsillectomy in Children

Gallagher, Thomas Q.; Hill, Courtney A.; Ojha, Shilpa; Ference, Elisabeth H.; Keamy, Donald G.; Williams, Michael; Hansen, Maynard; Maurer, Rie; Collins, Corey; Setlur, Jennifer; Capra, Gregory; Brigger, Matthew T.; Hartnick, Christopher J.

doi:10.1001/2012.jama.11575

Cited by 63 publications

(64 citation statements)

References 25 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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“…PONV has a negative impact on patient comfort and postoperative complications, which may be attributed to surgical site irritation that is caused by regurgitated gastric fluids and/or increase of local pressure in the vascular bed. Therefore, proper and accurate handling and treatment strategies for PONV are still required (9,10).…”

Section: Discussionmentioning

confidence: 99%

“…Despite the absence of a universally accepted protocol to treat the condition, ondansetron, dolasetron, dexamethasone, droperidol, dimenhydrinate and perphenazine are the main agents used in medical treatment, either alone or in combination (2,10,(20)(21)(22). As an alternative approach, Dundee et al (7,23) first introduced acupuncture applications for PONV in 1986 and then in 1989.…”

Section: Discussionmentioning

confidence: 99%

Acupuncture as an Antiemetic in Children who Underwent Adenoidectomy and/or Tonsillectomy

Özmert¹,

Salman²,

Sever³

et al. 2016

Turk J Anaesth Reanim

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Amaç: Postoperatif kusma genel anestezi sonrasında en sık karşıla-şılan problemlerden biridir. Etiyolojide pek çok faktörün tek başı-na veya birlikte etkili olduğu bilinmektedir. Akupunktur, Dünya Sağlık Örgütünün tamamlayıcı tedavi metodu olarak kabul ettiği bir medikal tekniktir. Burada çocuk hastalarda adenoidektomi ve/ veya tonsillektomi sonrasında görülen kusmanın tedavisi amacıyla Akupunktur deneyimimiz sunulmaktadır.Yöntemler: Çalışmaya genel anestezi altında adenoidektomi ve/ veya tonsillektomi uygulanan, 2-14 yaş arasında, ASA I-II, (n=70) hastalar dahil edildi. Hastalar çalışma ve kontrol grubu olarak, rastgele iki gruba ayrıldılar. Çalışma grubunda, akupunktur iğnesi intraoperatif dönemde 20 dakika P6 noktasında uygulandı. Gruplara postoperatif dönemde antiemetik herhangi bir tedavi verilmedi. Hastalar postoperatif dönemde grupları bilmeyen hemşireler tarafında takip edildi. Bulgular: Yaş, cinsiyet, girişim türü, anestezi süresi, girişim süresi, cerrahi uygulama ve ASA skorları göz önüne alındığında gruplar arasında istatistiksel olarak anlamlı farklılık saptanmadı. Grupların kusma sayıları karşılaştırıldığında ise anlamlı farklılık olduğu saptandı. Akupunktur uygulanan grupta kusma sıklığının diğer gruba göre 0,28 kat daha az olduğu görüldü.Sonuç: Çalışmamızın sonuçları, akupunktur uygulamasının postoperatif kusmayı azaltmada açık bir etkinliği olduğunu gös-termektedir. Akupunkturun rutin kullanımı postoperatif hasta konforuna katkıda bulunmanın yanısıra tedavi veya profilaksi amacıyla ilaç kullanımını azaltacaktır.Anahtar kelimeler: Akupunktur, postoperatif kusma, adenoidektomi, tonsillektomi Objective: Postoperative vomiting (POV) is one of the most common problems following general anaesthesia, and many factors, either solely or in combination, may play a role in aetiology. Acupuncture is a technique that the World Health Organization has accepted as a complementary treatment. This study presents our experience with acupuncture for POV treatment in a study of paediatric tonsillectomy cases. Methods:The study included ASA I-II patients (n=70) aged 2-14 years who underwent tonsillectomy and/or adenoidectomy under general anaesthesia. The patients were randomly divided into the following two groups: control and study group. In the study group, an acupuncture needle was intraoperatively applied to the P6 acupuncture point for 20 min. Antiemetics were not administered to either group because of the standard applications in the preoperative period. The patients were postoperatively evaluated by nurses who were unaware about the techniques used in either group.Results: No statistically significant difference was determined between the groups with regard to age, sex, nature of the operation, duration of anaesthesia, duration of the operation, surgical method and ASA scores. A statistically significant difference was determined between the groups with respect to vomiting rates. The acupuncture group presented with 0.28-times fewer vomiting episodes than the control group. Conclusion:The results of the stud...

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“…Le critère d'évaluation principal de cette étude était le saignement postopératoire chez les patients recevant de la dexaméthasone ou un placebo. 22 Les auteurs n'ont observé aucune augmentation en matière de saignement significatif d'un point de vue clinique, défini comme un saignement nécessitant une réadmission ou une réopération. Par conséquent, les données probantes selon lesquelles la dexaméthasone ne cause pas de saignement important d'un point de vue clinique après une amygdalectomie semblent convaincantes.…”

Section: Innocuité Deunclassified

“…The authors looked at postoperative bleeding as a primary end point in patients receiving either dexamethasone or placebo. 22 They found that there was no increase in clinically significant bleeding, which was defined as bleeding that required readmission or reoperation. The evidence seems to be convincing, therefore, that dexamethasone does not cause clinically important post-tonsillectomy 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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Perioperative Dexamethasone Administration and Risk of Bleeding Following Tonsillectomy in Children

Cited by 63 publications

References 25 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

Acupuncture as an Antiemetic in Children who Underwent Adenoidectomy and/or Tonsillectomy

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

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