THE EFFECT OF INTRAVENOUS DEXAMETHASONE IN PEDIATRIC ADENOTONSILLECTOMY

Objective: To determine whether the intravenous administration of dexa methasone sodium phosphate before tonsillectomy and adenoidectomy can reduce the morbidity from, and increase the safety of, this procedure. Design: Prospective, randomized, double-blind, placebo-controlled cli nical trial. Setting: A university medical center, caring for both amb ulatory and hospitalized children. Patients: Eighty children aged 3 to 15 years undergoing tonsillectomy and adenoidectomy for either chroni c tonsillitis or adenotonsillar hypertrophy (obstructive sleep apnea a nd/or upper airway obstruction). Interventions: Forty-one children rec eived intravenous dexamethasone sodium phosphate (1 mg/kg up to 16 mg) and 39 received placebo before undergoing an electrocautery dissectio n tonsillectomy and adenoidectomy. Main Outcome Measures: Postoperativ e oral intake, pain, vomiting, temperature, and complications. Results : Patients who received intravenous dexamethasone had significantly le ss trismus, vomiting, and elevations of temperature 6 hours after surg ery and more oral intake (liquids and soft solids) at 24 hours. Three children, all of whom were in the placebo group, had emergency departm ent visits for pain and dehydration. Each group had one child who had a secondary hemorrhage (no surgery needed), one child who had pneumoni a, and one child who had night terrors. Conclusions: Treatment with in travenous dexamethasone before electrocautery tonsillectomy and adenoi dectomy is safe, increases early postoperative oral intake, and decrea ses morbidity.