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A meta-analysis of dexamethasone use with tonsillectomy
A C Goldman1, S Govindaraj, R M Rosenfeld
1Department of Otolaryngology, SUNY-Health Science Center, Brooklyn, New York, USA.
Summary
Perioperative intravenous dexamethasone significantly reduces postoperative emesis and improves diet tolerance in children after tonsillectomy. Approximately four children require treatment to prevent one instance of emesis.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Postoperative nausea and vomiting (PONV) and delayed diet advancement are significant concerns following tonsillectomy.
- Dexamethasone is a corticosteroid with antiemetic properties.
Purpose of the Study:
- To quantitatively assess the impact of perioperative intravenous dexamethasone on recovery after tonsillectomy.
- To evaluate the effect of dexamethasone on postoperative emesis and diet tolerance.
Main Methods:
- A meta-analysis was conducted on double-blind randomized-controlled trials.
- Six studies met the inclusion criteria.
- Data on postoperative emesis and return to a soft/regular diet were extracted.
Main Results:
- Pooled analysis showed a 27% decrease in postoperative emesis with dexamethasone (P<0.00001).
- Dexamethasone increased soft/regular diet tolerance by 22% at 24 hours (P<0.001).
- Significant heterogeneity and low precision were noted for diet tolerance data.
Conclusions:
- Perioperative dexamethasone administration positively impacts tonsillectomy recovery.
- Approximately 4 children need dexamethasone to prevent 1 episode of emesis.
- While beneficial for diet tolerance, heterogeneity limits definitive conclusions.