Determination of optimum dosage of intraoperative single dose dexamethasone in pediatric tonsillectomy and adenotonsillectomy

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Abstract

Objective

Our objective is to determine the optimum dosage of intraoperative single dose dexamethasone and its effect upon postoperative morbidity in pediatric tonsillectomy and adenotonsillectomy patients.

Study design and methods

Totally 150 pediatric patients whom underwent adenotonsillectomy or tonsillectomy surgery are offered to participate in this study at otorhinolaryngology clinic between 2002 and 2003. 150 patients are divided into three randomized groups, each composed of fifty patients. Anesthesia protocol is standardized in each group and 0.2 mg/kg intraoperative dexamethasone is given to first group, 0.7 mg/kg (maximum dose 25 mg) intraoperative dexamethasone is given to second group and third group is accepted as control group without giving any intravenous dexamethasone. Each group is compared for postoperative nausea, vomiting and tolerability to take oral foods within first 24 h with the same questionnaire.

Results

There is significantly higher ratio of postoperative nausea and vomiting within first 24 h in group III (80%) when compared with group I (8%) (p: 0.001; p < 0.01) and group II (4%) (p: 0.001; p < 0.01). Also there is significantly higher ratio of patient's tolerability to take oral semisolid/solid foods within postoperative first 24 h in group II (94%) when compared with group I (58%) (p: 0.001; p < 0.01) and group III (12%) (p: 0.001; p < 0.01). We didn’t encounter any side effect of dexamethasone in group I and II.

Conclusions

We thought that 0.7 mg/kg dosage of IV dexamethasone is much a preferable choice depending of its effectiveness on decreasing postoperative morbidity rather than 0.2 mg/kg dosage and beside to this advantage we didn’t encounter any side effects.

Introduction

Tonsillectomy is one of the most common surgical procedure in worldwide. Posttonsillectomy morbidity especially nausea, vomiting and delay on taking oral foods is still a clinical problem even developments in surgical and anesthetical techniques [1]. There are many studies in literature about decreasing postadenotonsillectomy morbidity of patients. Literature studies showed that intraoperative intravenous (IV) dexamethasone obviously decreases posttonsillectomy morbidity [2], [3], [4], [5], [6]. But there is no consensus about optimum dosage of intravenous dexamethasone in literature. Intraoperative dexamethasone dosage in literature studies changes between 0.15 mg/kg and 1 mg/kg [7].

In this clinical study we aimed to determine the optimum dosage of intraoperative single dose dexamethasone and its effect upon postoperative morbidity in pediatric tonsillectomy and adenotonsillectomy patients.

Section snippets

Materials and methods

We carried out a prospective, single-blinded, randomized comparative study to examine the efficacy of intraoperative single dose dexamethasone. Totally 150 pediatric patients whom underwent adenotonsillectomy or tonsillectomy are offered to participate in this study at otorhinolaryngology clinic of Bezm-i Alem Vakıf Gureba State Hospital for Research and Training between 2002 and 2003. 150 patients are divided into three randomized groups, each composed of fifty patients equally. Randomization

Results

A dosage of 0.2 mg/kg intraoperative dexamethasone is given to group I patients and four (8%) of the fifty patients showed nausea and vomiting postoperatively. In group II patients 0.7 mg/kg dose of intraoperative dexamethasone is given and only two (4%) of fifty patients showed nausea and vomiting. 40 patients (80%) of control group showed nausea and vomiting. When comparing about tolerability to start taking oral foods within first 24 h, 29 patients in group I, 47 patients in group II and only 6

Discussion

Otorhinolaryngologists studied about the effects of systemic corticosteroids upon posttonsillectomy morbidity within last 30 or 35 years [8]. But there is still no consensus about the usage of corticosteroids routinely [9].

Posttonsillectomy morbidity especially nausea, vomiting and delay on taking oral semisolid/solid foods is still a clinical problem [7]. Steward et al. found incidence of postadenotonsillectomy nausea and vomiting about 70% [10]. Vomiting causes distress, anxiety, dehydration

Conclusion

In our study we found that there is statistically significant decrease of postoperative morbidity in patients who were given intraoperative single dose dexamethasone during tonsillectomy or adenotonsillectomy. We thought that 0.7 mg/kg dosage of IV dexamethasone is much a preferable choice depending on its effectiveness on decreasing postoperative morbidity rather than 0.2 mg/kg dosage and beside to this advantage we didn’t encounter any side effects.

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    Three studies 29−31were based in Saudi Arabia. Two studies35,36 were from Turkey, one from Australia,27 Iran,18 America,32 Canada,33 Czech Republic,17 Egypt,5 United Arab Emirates,38 Brazil,39 Lebanon,42 and Japan.16 The dosage of dexamethasone varied, range from 0.05 mg/kg to 1 mg/kg.

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    In total, 61 studies were included in this review (39 RCTs and 22 NRS). Of the 39 RCTs, 32 compared dexamethasone with another intervention;7 16–46 of these, 17 studies involving 1973 participants did not report haemorrhage rate.17 18 20 22–24 27 31–40 In the remaining seven randomized studies, all participants received dexamethasone,6 47–52 and of these, four did not report haemorrhage rate (588 participants).6 48 51 52

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