Dexamethasone or combined with others for postoperative nausea and vomiting in children: A systematic review

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Pharmacology

Background:

• Postoperative nausea and vomiting (PONV) is a frequent and distressing complication in pediatric surgical patients.
• Effective PONV prophylaxis is crucial for improving pediatric patient outcomes and satisfaction.

Purpose of the Study:

• To systematically evaluate the efficacy and safety of dexamethasone, alone or in combination with other agents, for preventing PONV in children.
• To determine optimal dexamethasone dosing strategies for PONV prevention.

Main Methods:

• A systematic literature review was performed, searching databases from inception to March 2019.
• Data from 20 studies involving 2505 pediatric participants were pooled using a random-effect model.
• Incidence of PONV and postoperative vomiting (POV) within 24 hours were primary outcomes.

Main Results:

• Dexamethasone significantly reduced the incidence of PONV and POV within 24 hours compared to control groups.
• The lowest risk ratio (RR) for PONV was observed in the subgroup receiving dexamethasone ≥0.5 mg/kg.
• Combination therapy with dexamethasone also demonstrated significant efficacy in reducing POV incidence; few adverse events were reported.

Conclusions:

• Dexamethasone is an effective agent for preventing PONV in pediatric patients.
• Higher dexamethasone doses (≥0.5 mg/kg) appear most effective.
• Multimodal approaches incorporating dexamethasone offer enhanced PONV prevention strategies in children.