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Published on: November 6, 2019
Dexamethasone administration and postoperative bleeding risk in children undergoing tonsillectomy
Matthew T Brigger1, Michael J Cunningham, Christopher J Hartnick
1Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134. matt.brigger@alumni.vanderbilt.edu
Insights
Perioperative dexamethasone in children undergoing tonsillectomy did not increase postoperative hemorrhage risk. Higher doses of dexamethasone (1.0 mg/kg) were not associated with a dose-dependent increase in bleeding complications.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative hemorrhage is a significant complication following tonsillectomy.
- Dexamethasone is often used perioperatively, but its effect on hemorrhage risk is debated.
Purpose of the Study:
- To determine if perioperative dexamethasone administration is associated with a dose-dependent increase in postoperative tonsillectomy hemorrhage rates in children.
Main Methods:
- Retrospective review of 2788 children and adolescents undergoing tonsillectomy.
- Analysis of hemorrhage rates based on two intravenous dexamethasone doses (0.5 mg/kg vs. 1.0 mg/kg).
- Statistical adjustment for age, sex, diagnosis, and surgical technique.
Main Results:
- Adjusted analysis showed no significant association between higher dexamethasone dose (1.0 mg/kg) and increased hemorrhage risk.
- Odds ratios for any hemorrhage, readmission with operative intervention, or operative intervention alone were not significantly elevated.
Conclusions:
- Perioperative dexamethasone administration is not linked to a dose-dependent rise in postoperative hemorrhage after tonsillectomy in children.
- Findings suggest current dexamethasone dosing protocols are likely safe regarding hemorrhage risk.
Objective:
To assess whether administration of dexamethasone during tonsillectomy is associated with a dose-dependent increased rate of postoperative tonsillectomy hemorrhage.
Design:
Retrospective review of 2788 children and adolescents who underwent tonsillectomy with or without adenoidectomy for sleep-disordered breathing or infectious tonsillitis and received perioperative dexamethasone between January 1, 2002, and March 3, 2009. Patients underwent 1 of 3 methods of tonsillectomy, including extracapsular electrosurgical tonsillectomy, extracapsular radiofrequency ablation tonsillectomy, or intracapsular microdebrider tonsillotomy.
Setting:
Massachusetts Eye and Ear Infirmary.
Patients:
Two thousand seven hundred eighty-eight children and adolescents aged 2 to 18 years (hereinafter referred to as children) who underwent tonsillectomy with or without adenoidectomy.
Interventions:
Each child received 1 of 2 distinct intravenous doses of perioperative dexamethasone (0.5 mg/kg or 1.0 mg/kg) based on the protocol of the surgeon who performed the tonsillectomy; other aspects of care, including anesthetic technique, perioperative analgesia, and postoperative care, were equivalent between children.
Main Outcome Measures:
Occurrence of postoperative hemorrhage based on 3 severity stratification levels.
Results:
Ninety-four of the 2788 children experienced 104 episodes of postoperative hemorrhage. After adjusting for age, sex, primary diagnosis, and surgical technique, the odds ratio of experiencing a postoperative hemorrhage of any severity in children who received the 1.0-mg/kg compared with the 0.5-mg/kg dose was 0.66 (95% confidence interval [CI], 0.42-1.05). Children requiring readmission with or without the need for operative intervention demonstrated an adjusted odds ratio of 0.83 (95% CI, 0.51-1.36). An adjusted odds ratio of 0.71 (95% CI, 0.39-1.28) was seen in children requiring operative intervention.
Conclusion:
In this observational review of children undergoing tonsillectomy or adenotonsillectomy, perioperative dexamethasone administration is not associated with a dose-dependent elevation of postoperative hemorrhage rates after adjusting for age, sex, primary diagnosis, and surgical technique.
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