Steroids for improving recovery following tonsillectomy in children

Abstract

The evidence suggests that a single intravenous dose of dexamethasone is an effective, safe and inexpensive treatment for reducing morbidity from pediatric tonsillectomy.

The Steroid Controversy: Where Are We?

“…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].…”

“…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]. In their recent Clinical Practice Guideline report, the American Academy of Otolaryngology, Head and Neck Surgery panel made a ‘strong recommendation' that clinicians should administer a single, intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy [4].…”

“…Most published studies used a dexamethasone dose of 0.5 mg/kg; however, a systematic review of RCTs showed that doses have ranged from 0.15 to 1.00 mg/kg [5]. Maximum doses found in the same RCT ranged from 8 to 25 mg administered intravenously, usually given as one preoperative dose but occasionally in divided doses pre- and immediately postoperatively.…”

“…Furthermore, both the Society of Ambulatory Anesthesia and the American Academy of Otolaryngology, Head and Neck Surgery advocate for the intraoperative use of steroids [3,4]. Summarizing the available evidence, a Cochrane meta-analysis of randomized controlled trials (RCTs) concluded that a single dose of dexamethasone is ‘virtually without harmful effect' [5]. …”

How to Make Tonsillectomy a Safer Procedure: The Anaesthetist's View

“…Numerous authors have tried to provide evidence, based on analyses from very different study protocols, that dexamethasone was safe in this context [31,32,33]. A recently published study concluded that the administration of peri-operative dexamethasone was not associated with bleeding requiring inpatient admission or re-operation [34].…”