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La dexametasona y el riesgo de náuseas y vómitos y sangrado postoperatorio después de la amigdalectomía en niños: un
Christoph Czarnetzki1, Nadia Elia, Christopher Lysakowski
1Division of Anesthesiology, University Hospitals of Geneva, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland.
JAMA
|December 11, 2008
Resumen
La dexametasona redujo las náuseas y vómitos postoperatorios (PONV) en pacientes pediátricos con amigdalectomía en función de la dosis. Sin embargo, las dosis más altas aumentaron el riesgo de sangrado postoperatorio grave, lo que llevó a la terminación temprana del ensayo.
Área de la Ciencia:
- Anestesiología Pediátrica Anestesiología Pediátrica.
- Farmacología Farmacología.
- Resultados quirúrgicos.
Sus antecedentes:
- La dexametasona es un agente profiláctico común para las náuseas y vómitos postoperatorios (PONV) en la amigdalectomía pediátrica.
- La dosis óptima para prevenir PONV mientras se minimizan los riesgos sigue siendo objeto de investigación.
Objetivo del estudio:
- Para determinar si la dexametasona reduce el riesgo de PONV a las 24 horas después de la amigdalectomía de una manera dependiente de la dosis.
- Evaluar la asociación entre la dosis de dexametasona y la incidencia de eventos adversos, específicamente el sangrado postoperatorio.
Principales métodos:
- Un ensayo aleatorizado, controlado con placebo, en el que participaron 215 niños sometidos a amigdalectomía electiva.
- Los participantes recibieron dexametasona por vía intravenosa (0,05, 0,15, o 0,5 mg/kg) o placebo después de la inducción de la anestesia.
- Endpoint primario: PONV a las 24 horas; Endpoints secundarios: uso analgésico y efectos adversos.
Principales resultados:
- La dexametasona redujo significativamente la PONV de manera dependiente de la dosis (P<.001).
- La dosis de 0,5 mg/kg se asoció con un riesgo significativamente mayor de sangrado postoperatorio (riesgo relativo ajustado, 6,80; P = .003).
- Ocho niños requirieron una reoperación de emergencia debido a una hemorragia, todos los cuales recibieron dexametasona.
Conclusiones:
- La dexametasona disminuye efectivamente el riesgo de VPO después de la amigdalectomía pediátrica de una manera dependiente de la dosis.
- La dosis más alta (0,5 mg/kg) aumenta significativamente el riesgo de sangrado postoperatorio, lo que requiere precaución.
- El estudio se detuvo antes de tiempo debido a preocupaciones de seguridad con respecto al aumento del riesgo de sangrado con dosis más altas de dexametasona.
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