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Prophylactic dexamethasone for postoperative nausea and vomiting in pediatric strabismus surgery: a dose ranging and
Rashmi Madan1, Anuj Bhatia, Sajith Chakithandy
1*Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India; †Department of Anaesthetics, Queen Elizabeth Hospital, Norfolk; and ‡Department of Anesthetics, Addenbrookes Hospital, Cambridge, United Kingdom.
Insights
Dexamethasone effectively prevents postoperative nausea and vomiting (PONV) in children undergoing strabismus surgery. A low dose of 0.25 mg/kg dexamethasone is as effective as higher doses and superior to placebo.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) is a common complication in pediatric surgery.
- Strabismus surgery in children presents a significant risk for PONV.
- Effective prophylactic antiemetic strategies are crucial for pediatric patient recovery.
Purpose of the Study:
- To evaluate the efficacy and safety of different prophylactic intravenous dexamethasone doses for PONV in pediatric strabismus surgery.
- To compare low-dose (0.25 mg/kg) versus higher doses of dexamethasone against placebo.
- To assess the impact of dexamethasone on blood glucose, wound healing, and infection.
Main Methods:
- Double-blind, randomized, placebo-controlled trial involving 168 children (2-15 years).
- Administration of intravenous dexamethasone (0.25, 0.5, or 1.0 mg/kg) or saline post-anesthesia induction.
- Assessment of PONV at multiple intervals, rescue antiemetic use, blood glucose, and wound healing.
Main Results:
- Dexamethasone groups showed significantly less vomiting and required fewer rescue antiemetics compared to the placebo group.
- Severe PONV was significantly reduced in all dexamethasone groups versus placebo.
- No significant adverse effects on blood glucose or wound healing were observed across all groups.
Conclusions:
- Intravenous dexamethasone is effective in preventing PONV in pediatric strabismus surgery.
- A prophylactic dose of 0.25 mg/kg dexamethasone demonstrates efficacy comparable to higher doses and superior to placebo.
- Dexamethasone is a safe option for PONV prophylaxis in this pediatric surgical population.
Abstract:
In this double-blind, randomized, placebo-controlled study, we evaluated the efficacy and safety of different doses of prophylactic IV dexamethasone for postoperative nausea and vomiting (PONV) in 168 children (aged 2-15 yr) scheduled for strabismus surgery. Patients received IV dexamethasone 0.25 mg/kg (D 0.25), 0.5 mg/kg (D 0.5), 1.0 mg/kg (D 1), or saline (S) immediately after induction of general anesthesia. Patients were discharged 24 h after surgery. Nausea and vomiting were assessed at 0-2, 2-6, and 6-24 h after surgery. Blood glucose was measured preoperatively and at 4 h after study drug administration. Wound healing and infection were assessed after 1 wk. More patients in group S had vomiting at 0-2, 2-6, and 6-24 h (P = 0.001, P = 0.003, and P = 0.04, respectively) and required larger doses of rescue antiemetics compared with the dexamethasone groups. Fewer patients in the dexamethasone groups (6, 3, and 6 in D 0.25, D 0.5, and D 1, respectively) had severe PONV compared with group S (P = 0.001). No significant increase in postoperative blood glucose levels was observed and wound healing was satisfactory in all four groups. The results suggest that dexamethasone 0.25 mg/kg is more effective than saline and equally effective compared with larger doses for preventing PONV for pediatric strabismus surgery.
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