The effect of perioperative dexamethasone dosing on post-tonsillectomy hemorrhage risk

Yiu, Yin; Mahida, Justin B.; Cooper, Jennifer N.; Elsey, Nicole; Deans, Katherine J.; Minneci, Peter C.; Merrill, Tyler; Tobias, Joseph D.; Elmaraghy, Charles

doi:10.1016/j.ijporl.2017.04.033

Cited by 14 publications

(10 citation statements)

References 25 publications

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“…In this case, antibiotic therapy with Ceftriaxone, ciprofloxacin, gentamycin, metronidazole, and drainage of the intra-orbital abscess were used. Orbital and sub-periosteal abscesses, as well as orbital cellulitis, are the complications of ethmoidomaxillary sinusitis found by several authors [2,5,16], but in the present study, the medial frontal cerebral empyema and focal signs were found beyond the orbital cellulitis and the Chandler IV retro-orbital abscess, and this would be explained by the indirect propagation of the infection by the hematogenous route through the ophthalmic veins without valves. In our study, blood culture before starting antibiotic therapy and the search for soluble antigens would have increased the probability of identifying the germ in our study [6,17].…”

Section: Discussioncontrasting

confidence: 62%

Acute ethmoiditis complicated by intraorbital abscess, orbital cellulitis and cerebral empyema in a 14-year-old girl. About a case.

Colombe

Nabuloho

Opondjo

et al. 2022

Preprint

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Section: Discussioncontrasting

confidence: 62%

Acute ethmoiditis complicated by intraorbital abscess, orbital cellulitis and cerebral empyema in a 14-year-old girl. About a case.

Colombe

Nabuloho

Opondjo

et al. 2022

Preprint

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“…31 Further studies have produced equivocal results, suggesting a predominance of benefit over harm. 32,33 In addition, the safety of ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) has been questioned. Multiple studies have failed to demonstrate an association between NSAID use and PTH [22][23][24] ; however, recent investigations have shown a statistically significant increase in hemorrhages among patients taking ibuprofen during the extended postoperative period.…”

Section: Discussionmentioning

confidence: 99%

“…Although, the American Academy of Otolaryngology–Head and Neck Surgery 16 strongly recommends administering one dose of intraoperative steroids to control postoperative nausea and vomiting, there is past evidence suggesting that dexamethasone increases patients' risk of hemorrhage . Further studies have produced equivocal results, suggesting a predominance of benefit over harm . In addition, the safety of ibuprofen and other nonsteroidal anti‐inflammatory drugs (NSAIDs) has been questioned.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

et al. 2018

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Objectives/Hypothesis Although much is known about the incidence and risk factors for hemorrhage after tonsil surgery, the incidence and factors related to multiple episodes of hemorrhage are not well examined. Our objective was to identify risk factors that may contribute to multiple hemorrhages following tonsil surgery in children. Study Design Retrospective chart review. Methods A retrospective review was conducted of pediatric patients who experienced one or more hemorrhages following tonsillectomy/tonsillotomy, with or without adenoidectomy, between 2010 and 2016 at a single, tertiary‐care hospital. Risk factors for multiple hemorrhages were examined using a multivariable logistic regression model. Results Among the 11,140 patients who underwent tonsil surgery, 452 patients experienced one or more hemorrhages; 32 of these had multiple episodes of hemorrhage (7.1% of all patients with bleeds/0.3% of all patients). Older age (≥12 years: adjusted odds ratio [OR]: 3.13; 95% confidence interval [CI]: 1.47‐6.68) and high body mass index for age (≥85th percentile: adjusted OR: 2.26; 95% CI: 1.06‐4.85) were significantly associated with an increased risk of multiple hemorrhages in the multivariable model. Medical comorbidities, indications for surgery, surgical technique, intraoperative blood loss, and perioperative medications were not associated with multiple episodes of bleeding. Conclusions Multiple hemorrhages after tonsillectomy/tonsillotomy are uncommon. The risk of a second PTH after an initial episode is 7.1%, almost double the risk of a bleed after the initial tonsil surgery. Age > 12 years and high BMI for age may be associated with increased risk of rebleeding. After an initial bleed, increased surveillance may be warranted, particularly for patients with risk factors. Level of Evidence 4 Laryngoscope, 129:2765–2770, 2019

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“…In our study, although we use the prophylactic dexamethasone, the case of nausea and vomiting in the DEX + Alf2 group was more than that in the DEX + Alf1 group. Dexamethasone can decrease postoperative edema and improve subsequent oral take after tonsillectomy because it has anti-inflammatory effects (Yiu et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

The Effects of Different Doses of Alfentanil and Dexmedetomidine on Prevention of Emergence Agitation in Pediatric Tonsillectomy and Adenoidectomy Surgery

et al. 2022

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Background: Emergence agitation (EA) is a common problem often observed in children after sevoflurane anesthesia, which can be prevented by dexmedetomidine and alfentanil. This study aims to compare the effectiveness of dexmedetomidine alone and with different doses of alfentanil in preventing EA in children under sevoflurane anesthesia.Materials and Methods: In a double-blind trial, 80 children (ASA I or II, 3–7 years old) undergoing tonsillectomy alone and adenotonsillectomy with sevoflurane anesthesia were randomly assigned into four groups: the control group, dexmedetomidine (DEX) group, dexmedetomidine plus 10 μg/kg alfentanil group (DEX + Alf1), and dexmedetomidine plus 20 μg/kg alfentanil group (DEX + ALf2). The incidence of EA was assessed with the Aono’s scale, and the severity of EA was evaluated with the Pediatric Anesthesia Emergence Delirium (PAED) scale. The time of tracheal extubation and time of wake were recorded. Postoperative pain and complications such as nausea and vomiting, cough, laryngospasm, and bradycardia were recorded.Results: The incidence of EA was 50% in the control group, 25% in the DEX group, and 5% in the DEX + Alf1 group, and it never happened in the DEX + Alf2 group. The Aono’s scale, the PAED scale, and the FLACC scale in the control group and the DEX group were significantly more than those in the DEX + Alf1 group and the DEX + Alf2 group after the tracheal extubation (p < 0.05). The time of tracheal extubation of the control group and the DEX group were significantly shorter than those in the DEX + Alf1 group and the DEX + Alf2 group (p < 0.05). The awakening time of the DEX + Alf2 group is significantly longer than those in other groups (p < 0.05). The case of postoperative nausea and vomiting in the DEX + Alf1 group was fewer than those in the other groups (p < 0.05). And, the cases of cough and laryngospasm and bronchospasm in the DEX + Alf1 group and the DEX + Alf2 group were significantly less than those in the control group and the DEX group after the tracheal extubation (p < 0.05).Conclusion: The combined administration of alfentanil and dexmedetomidine can reduce EA in children undergoing tonsillectomy alone and adenotonsillectomy with sevoflurane anesthesia. Dexmedetomidine plus 10 μg/kg alfentanil seems to be more appropriate than other dose combinations as it reduced EA and postoperative nausea and vomiting but did not prolong the time to awake.

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The effect of perioperative dexamethasone dosing on post-tonsillectomy hemorrhage risk

Cited by 14 publications

References 25 publications

Acute ethmoiditis complicated by intraorbital abscess, orbital cellulitis and cerebral empyema in a 14-year-old girl. About a case.

Acute ethmoiditis complicated by intraorbital abscess, orbital cellulitis and cerebral empyema in a 14-year-old girl. About a case.

Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

The Effects of Different Doses of Alfentanil and Dexmedetomidine on Prevention of Emergence Agitation in Pediatric Tonsillectomy and Adenoidectomy Surgery

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