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Title

Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial

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Published in JAMA (Journal of the American Medical Association). 2008, vol. 300, no. 22, p. 2621-30
Abstract CONTEXT: Dexamethasone is widely used to prevent postoperative nausea and vomiting (PONV) in pediatric tonsillectomy. OBJECTIVE: To assess whether dexamethasone dose-dependently reduces the risk of PONV at 24 hours after tonsillectomy. DESIGN, SETTING, AND PATIENTS: Randomized placebo-controlled trial conducted among 215 children undergoing elective tonsillectomy at a major public teaching hospital in Switzerland from February 2005 to December 2007. INTERVENTIONS: Children were randomly assigned to receive dexamethasone (0.05, 0.15, or 0.5 mg/kg) or placebo intravenously after induction of anesthesia. Acetaminophen-codeine and ibuprofen were given as postoperative analgesia. Follow-up continued until the 10th postoperative day. MAIN OUTCOME MEASURES: The primary end point was prevention of PONV at 24 hours; secondary end points were decrease in the need for ibuprofen at 24 hours and evaluation of adverse effects. RESULTS: At 24 hours, 24 of 54 participants who received placebo (44%; 95% confidence interval [CI], 31%-59%) had experienced PONV compared with 20 of 53 (38%; 95% CI, 25%-52%), 13 of 54 (24%; 95% CI, 13%-38%), and 6 of 52 (12%; 95% CI, 4%-23%) who received dexamethasone at 0.05, 0.15, and 0.5 mg/kg, respectively (P<.001 for linear trend). Children who received dexamethasone received significantly less ibuprofen. There were 26 postoperative bleeding episodes in 22 children. Two of 53 (4%; 95% CI, 0.5%-13%) children who received placebo had bleeding compared with 6 of 53 (11%; 95% CI, 4%-23%), 2 of 51 (4%; 95% CI, 0.5%-13%), and 12 of 50 (24%; 95% CI, 13%-38%) who received dexamethasone at 0.05, 0.15, and 0.5 mg/kg, respectively (P =.003). Dexamethasone, 0.5 mg/kg, was associated with the highest bleeding risk (adjusted relative risk, 6.80; 95% CI, 1.77-16.5). Eight children had to undergo emergency reoperation because of bleeding, all of whom had received dexamethasone. The trial was stopped early for safety reasons. CONCLUSION: In this study of children undergoing tonsillectomy, dexamethasone decreased the risk of PONV dose dependently but was associated with an increased risk of postoperative bleeding. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00403806.
Keywords AdolescentAnalgesics, Non-Narcotic/therapeutic useAnti-Inflammatory Agents, Non-Steroidal/therapeutic useAntiemetics/administration & dosage/therapeutic useChildChild, PreschoolDexamethasone/administration & dosage/therapeutic useDose-Response Relationship, DrugFemaleHumansIbuprofen/therapeutic useMalePain, Postoperative/drug therapyPostoperative Hemorrhage/epidemiologyPostoperative Nausea and Vomiting/prevention & controlRiskTonsillectomy
Stable URL http://archive-ouverte.unige.ch/unige:1298
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PMID: 19066382
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Research groups Groupe Dulguerov Pavel (ORL et chirurgie cervico-faciale) (145)
Groupe Desmeules Jules (pharmacologie/toxicologie) (567)
La Médecine Périopératoire et l'anesthésie (70)

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Deposited on : 2009-04-01

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