THE EFFECT OF PREOPERATIVE DEXAMETHASONE ON THE IMMEDIATE AND DELAYEDPOSTOPERATIVE MORBIDITY IN CHILDREN UNDERGOING ADENOTONSILLECTOMY

In this prospective, randomized, double-blind, placebo-controlled stud y, we examined the effect of preoperative dexamethasone on postoperati ve nausea and vomiting (PONV) and 24-h recovery in children undergoing tonsillectomy. One hundred thirty children, 2-12 yr of age, ASA physi cal status I or II, completed the study. All children received oral mi dazolam 0.5-0.6 mg/kg preoperatively. Anesthesia was induced with halo thane and nitrous oxide in 60% oxygen and maintained with nitrous oxid e and isoflurane. Intubation was facilitated by mivacurium 0.2 mg/kg. Each child received fentanyl 1 mu g/kg IV before initiation of surgery , as well as dexamethasone 1 mg/kg (maximal dose 25 mg) (steroid group ) or an equal volume of saline (control group). Intraoperative fluids were standardized to 25-30 mL/kg lactated Ringer's solution. All tonsi llectomies were performed under the supervision of one attending surge on using an electro-dissection technique. Postoperatively, fentanyl an d acetaminophen with codeine elixir were administered as needed for pa in. Rescue antiemetics were administered when a child experienced two episodes of retching and/or vomiting. Before home discharge, the incid ence of PONV, need for rescue antiemetics, quality of oral intake, and analgesic requirements did not differ between groups. However, during the 24 h after discharge, more patients in the control group experien ced PONV (62% vs 24% in the steroid group) and complained of poor oral intake. Additionally, more children in the control group (8% vs 0% in the steroid group) returned to the hospital for the management of PON V and/or poor oral intake. The preoperative administration of dexameth asone significantly decreased the incidence of PONV over the 24 h afte r home discharge in these children. Implications: In this double blind , placebo-controlled study, we examined the efficacy of a single large dose (1 mg/kg; maximal dose 25 mg) of preoperative dexamethasone on p osttonsillectomy postoperative nausea and vomiting (PONV) in children 2-12 yr of age undergoing tonsillectomy. Compared with placebo, dexame thasone significantly decreased the incidence of PONV in the 24 h afte r discharge, improved oral intake, decreased the frequency of parental phone calls, and resulted in no hospital returns for the management o f PONV and/or poor oral intake.