The effect of dexamethasone on post-tonsillectomy nausea, vomiting and bleeding

Abstract

It has been stated, that the administration of Dexamethasone has an impact on the morbidity following tonsillectomy.Objective: To re-calculate the blood values for Dexamethasone when given as fixed doses and to evaluate the effect of Dexamethasone on post-operative nausea, vomiting and bleeding rates following tonsillectomy. Materials and methods:The charts of 272 children (2-15 years) who had undergone tonsillectomy were analyzed. The rates of post-operative nausea, vomiting and bleeding in relation to Dexamethasone were calculated-in general and different doses (0 mg/kg, <0.15 mg/kg, >0.15 mg/kg). Study design:Retrospective cohort study.Results: Dexamethasone was administered in 121 children (43.7%) according to the preference of the anesthesist (mean dose: 0.2 +/-0.12 mg/kg; range: 0.04 -0.62 mg/kg). There was no significant difference in nausea and vomiting (p=0.953) or bleeding (p=0.827) across groups receiving or not receiving Dexamethasone. Stratification into three different groups of Dexamethasone concentration also did not identify a dose-related risk of postoperative nausea or vomiting (p=0.98) or bleeding (p=0.71). Conclusion:At least under common non-controlled conditions in the clinic, Dexamethasone does not appear to have an effect on nausea or vomiting or bleeding following tonsillectomy. Braz J Otorhinolaryngol. 2011;77(3):373-9. ORIGINAL ARTICLE BJORL

Gender-specific risk factors in post-tonsillectomy hemorrhage

“…This may be caused by the more frequent occurrence of PTAs in men, and the subsequently increased rate of uvula edema. However, upto-date studies and meta-analyses have failed to show an increased risk of PTH after dexamethasone application [46,47].…”

The Steroid Controversy: Where Are We?

“…In the 3 years since the release of the study by Czarnetzki et al [23], there have been several studies published which demonstrate no increased risk of bleeding with dexamethasone [28,62,63]. Furthermore, some of the trials actually found a significantly reduced risk of bleeding with dexamethasone versus placebo.…”

Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis

“…They were all retrospective case note reviews and two of them retrieved 2 week follow-up data. In one of the studies, a single method of tonsil dissection was used, 61 while in the other studies, there were several methods recorded. 54 58 In the retrospective chart review conducted by Conley and Ellison, 54 children who received dexamethasone were operated on using a standard surgical technique-cold-knife dissection and snare and haemostasis was achieved using tonsillar packs dipped in bismuth subgallate-phenylephrine hydrochloride mixture followed by suction electrocautery and a 3 min observation period.…”

“…The report of one study specifies that dexamethasone was administered or withheld according to the anaesthetist's preference. 61 NSAIDs were administered Table 2 Risk of bias for randomized studies which compare dexamethasone with another intervention and reported haemorrhage rate. Dex, dexamethasone; ED, emergency department; NSAID, non-steroidal anti-inflammatory drug; POD, postoperative day; PONV, postoperative nausea and vomiting; postop, postoperative…”

“…54 In a third study, there was no difference between the intervention groups, but dexamethasone had been administered according to anaesthetist preference (no further details available), and it is therefore possible that children with an increased risk of haemorrhage were not administered dexamethasone. 61 All three studies were retrospective chart reviews using hospital records. Although they report haemorrhage rates which correspond to those quoted in the literature, 2 there is some evidence that retrospective chart review underestimates haemorrhage rate.…”