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Administración perioperatoria de dexametasona y riesgo de sangrado después de amigdalectomía en niños: un ensayo
Thomas Q Gallagher1, Courtney Hill, Shilpa Ojha
1Department of Otolaryngology, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
JAMA
|September 27, 2012
Resumen
La dexametasona no aumentó significativamente el sangrado severo después de la amigdalectomía pediátrica. Sin embargo, puede conducir a eventos de sangrado más subjetivos, lo que justifica una cuidadosa consideración de su uso.
Área de la Ciencia:
- Cirugía pediátrica en cirugía pediátrica.
- Anestesiología Anestesiología.
- La otorrinolaringología otorrinolaringología.
Sus antecedentes:
- Los corticosteroides se usan con frecuencia en la amigdalectomía pediátrica para controlar las náuseas y los vómitos.
- Existen preocupaciones con respecto a su potencial para elevar los riesgos de hemorragia perioperatoria y postoperatoria.
Objetivo del estudio:
- Evaluar el impacto de la dexametasona en el sangrado posterior a la amigdalectomía en niños.
- Para probar la hipótesis de que la dexametasona no aumenta los eventos de sangrado en más del 5% en comparación con el placebo.
Principales métodos:
- Un ensayo multicéntrico, aleatorizado, doble ciego, controlado con placebo que involucró a 314 niños de 3 a 18 años.
- Los participantes recibieron una sola dosis perioperatoria de dexametasona o un placebo.
- La gravedad de la hemorragia se evaluó utilizando un seguimiento postoperatorio de 14 días y una escala de sangrado estandarizada.
Principales resultados:
- El estudio incluyó a 157 niños en cada grupo.
- El sangrado de nivel I (subjetivo) se produjo en el 7,0% del grupo de dexametasona frente al 4,5% en el grupo placebo.
- Las tasas de sangrado clínicamente significativo (nivel II y III) fueron bajas y no aumentaron significativamente con la dexametasona.
Conclusiones:
- La dexametasona perioperatoria en la amigdalectomía pediátrica no está relacionada con el sangrado excesivo clínicamente significativo (nivel II/III).
- Se cruzó el umbral de no inferioridad para el sangrado subjetivo (Nivel I), lo que sugiere un aumento potencial en eventos de sangrado menores.
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