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デキサメタゾンと子供における桃体切除術後の吐きや吐きや術後の出血のリスク:ランダム化試験
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
まとめ
デキサメタゾンは,小児桃切除手術患者の術後の吐き気と嘔吐 (PONV) を,投与量に依存して減少させた. しかし,より高い用量は重度の術後の出血のリスクを高め,早期に試験終了につながった.
科学分野:
- 小児麻酔医の麻酔学について
- 薬理学 薬理学とは
- 外科手術の結果について
背景:
- デキサメタゾンは,小児トンジル切除術における手術後の吐き気と嘔吐 (PONV) の一般的な予防薬です.
- PONVを予防し,リスクを最小限に抑えるための最適な用量は,現在も調査中です.
研究 の 目的:
- デキサメタゾンが桃体切除術後の24時間後にPONVのリスクを減らせるかどうかを,用量依存の方法で判断する.
- デキサメタゾンの投与量と有害事象,特に手術後の出血の発生率との関連性を評価する.
主な方法:
- 選択性桃切除手術を受けた215人の子どもを対象としたランダム化,プラセボ対照試験.
- 参加者は,静脈内デキサメタゾン (0.05,0.15,または0.5 mg/kg) またはプラセボを麻酔後誘導として投与された.
- 主要エンドポイント:24時間後のPONV;二次エンドポイント:鎮痛剤の使用と副作用.
主要な成果:
- デキサメタゾンは,PONVを投与量に依存して有意に減少させました (P<.001).
- 0.5 mg/kgの投与量は,手術後の出血のリスクが著しく増加した (調整された相対リスク,6.80; P = .003).
- 8人の子どもは出血のため緊急再手術を必要とし,全員がデキサメタゾンを投与された.
結論:
- デキサメタゾンは,小児トンジル切除術後のPONVリスクを,投与量に依存した方法で効果的に低下させます.
- 最も高い用量 (0.5 mg/kg) は,手術後の出血のリスクを大幅に高め,注意が必要です.
- この研究は,より高いデキサメタゾンの用量で出血リスクの増加に関する安全性に関する懸念のために早期に中止されました.
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