International Journal of Pediatric Otorhinolaryngology
Determination of optimum dosage of intraoperative single dose dexamethasone in pediatric tonsillectomy and adenotonsillectomy
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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2023, Operative Techniques in Otolaryngology - Head and Neck SurgeryComparison of high-versus low-dose corticosteroid administration on post-tonsillectomy outcomes
2023, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :No dosing related differences were seen in the dexamethasone groups; however, the study was not powered to assess these differences. A study by Karaman et al. also looked at the optimum dosing of intraoperative dexamethasone in pediatric tonsillectomy [17]. They randomized 150 pediatric patients into 3 groups: a control group, and two steroid groups either receiving 0.2 mg/kg or 0.7 mg/kg of dexamethasone up to 25 mg.
Dexamethasone or combined with others for postoperative nausea and vomiting in children: A systematic review
2020, Asian Journal of SurgeryCitation Excerpt :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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2016, Smith's Anesthesia for Infants and Children, Ninth EditionDexamethasone and haemorrhage risk in paediatric tonsillectomy: A systematic review and meta-analysis
2014, British Journal of AnaesthesiaCitation Excerpt :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
Effect of dexamethasone on nausea, vomiting, and pain in paediatric tonsillectomy
2012, British Journal of Anaesthesia