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The efficacy of perioperative steroid therapy in pediatric primary palatoplasty
C W Senders1, S M Di Mauro, H A Brodie
1Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento 95817, USA.
Insights
Perioperative steroid therapy significantly reduced airway distress and fever in pediatric cleft palate repair. This suggests steroids should be a standard part of care for primary palatoplasty patients.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pharmacology
Background:
- Cleft palate repair is a common pediatric surgical procedure.
- Postoperative complications such as airway distress and fever can occur.
- The role of perioperative steroid therapy in mitigating these complications is not well-established.
Purpose of the Study:
- To evaluate the efficacy of perioperative steroid administration in reducing postoperative complications following primary palatoplasty in children.
- To determine if steroid therapy impacts outcomes like airway distress, fever, oral intake, discharge readiness, and fistula formation.
Main Methods:
- A prospective, double-blind, randomized, placebo-controlled trial was conducted.
- Forty-five children under 48 months undergoing primary palatoplasty were enrolled.
- Participants received either intravenous dexamethasone or a placebo perioperatively.
Main Results:
- Steroid therapy significantly decreased the incidence of postoperative airway distress (p = .05).
- A significant reduction in postoperative fever was observed with steroid use (p = .02).
- No significant differences were found in oral fluid intake, discharge eligibility, or palatal fistula rates.
Conclusions:
- Perioperative steroid therapy is effective in lowering the risk of postoperative airway distress and fever in pediatric primary palatoplasty.
- These findings support the routine use of perioperative steroids in children undergoing primary cleft palate repair.
- Steroid administration may be a beneficial adjunct to standard surgical care for this population.
Objective:
To determine if perioperative steroid therapy benefits pediatric primary palatoplasty patients.
Design:
A prospective, double-blind, randomized trial with a placebo control.
Setting:
An academic medical center.
Patients:
Forty-five children undergoing primary repair of their cleft palate between 1989 and 1996 who were under the age of 48 months and without developmental delay or any associated syndrome.
Interventions:
Intravenous dexamethasone sodium phosphate (0.25 mg/kg) or a placebo (5% dextrose in water) immediately preoperatively and once every 8 hours for two doses postoperatively.
Main Outcome Measures:
Postoperative airway distress, fever, oral fluid intake, discharge eligibility, and palatal fistula formation.
Results:
Perioperative steroid therapy significantly reduced the incidence of postoperative airway distress (p = .05) and postoperative fever (p = .02); postoperative oral fluid intake, discharge eligibility, and palatal fistula formation were not significantly affected.
Conclusions:
Perioperative steroids effectively lower the risk of postoperative airway distress and postoperative fever in children undergoing the primary repair of their cleft palate. This finding favors a customary role for perioperative steroid therapy in pediatric primary palatoplasty.
