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Is Dexamethasone Safe for Pediatric Tonsillectomy Patients?

Swiss trial shows the steroid reduces PONV but increases risk of post-op bleeding.

Published: December 12, 2008

Swiss researchers examining the use of dexamethasone to curb PONV in pediatric tonsillectomy patients stopped their trial early when children who received the steroid were shown to have a higher risk of post-operative bleeding.

Eleven percent of children taking the lowest dose (0.05 mg/kg) of dexamethasone and 24 percent of children taking the highest dose (0.5 mg/kg) experienced bleeding, with eight children (all of whom were in the dexamethasone group) needing further surgery. Four percent of patients in the placebo group and in the 0.15 mg/kg dexamethasone group experienced post-op bleeding. All patients received acetaminophen-codeine and ibuprofen for post-op pain.

In addition to a higher risk of bleeding, patients who took dexamethasone also had a lower rate of post-operative nausea and vomiting than the placebo group, with higher doses of the steroid having the greatest effect on PONV.

The results of the Swiss trial, which was conducted among 215 pediatric patients between February 2005 and December 2007, are published in the Journal of the American Medical Association.

Despite the positive outcome on PONV, study author Martin R. Tramer, MD, of Geneva University Hospitals’ anesthesiology division, recommends that "children undergoing [tonsillectomy] should not receive dexamethasone prophylactically unless an adequately designed, valid study has shown that our findings can be refuted," according to HealthDay News.

Several U.S. physicians told HealthDay they weren’t convinced by the findings. "I give around 0.4 mg/kg [of dexamethasone], and I have many colleagues that do the same, and I have not experienced or seen this kind of bleeding," says Ramzi Younis, MD, chief of pediatric otolaryngology at the University of Miami School of Medicine.

Irene Tsikitas

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