The effect of dexamethasone on recovery from cleft palate surgery

Abstract

EDITOR: Cleft palate repair is most frequently performed in children between 6 months and 10 yr. Cleft palate surgery may cause swelling, vomiting, pain and poor oral intake. Dexamethasone has combined anti-emetic and anti-inflammatory effects, may decrease postoperative oedema and subsequently may improve oral intake [1-3]. Dexamethasone has been shown to reduce the incidence of vomiting by children after tonsillectomy [1,4,5]. We undertook this prospective double-blind randomized study to examine the effect of dexamethasone on recovery in children after cleft palate surgery. After we obtained hospital Ethics Committee approval and written, informed consent of the parents, 86 children aged 6 months to 10-yr-old ASA physical status I or II, undergoing cleft palate repair, using a standardized anaesthetic technique, were studied. Immediately after the induction of anaesthesia, the patients were randomly allocated to one of two groups, dexamethasone group (n = 43) receiving dexamethasone 0.5 mg kg−1 i.v. (intravenous), and the placebo group (n = 43) receiving normal saline. In addition to patient characteristics data, time to post anaesthesia care unit (PACU) discharge, first oral intake (delay between the arrival into PACU and the first oral intake), quality of oral intake (evaluated by the following scale 1: excellent, child requests food; 2: good, child accepts it when offered; 3: fair, child accepts it when coaxed; 4: poor, child refuses it) and vomiting were evaluated. There were no significant differences between the two groups with respect to age, weight, ASA physical status, duration of surgery or anaesthesia and PACU stay duration. The time to first oral intake was significantly shorter, and the quality of oral intake was significantly better, in the dexamethasone group. The incidence of postoperative vomiting was similar in the two groups. We conclude that dexamethasone 0.5 mg kg−1 i.v. improves the quality of oral intake and shortens the time to first oral intake in children undergoing cleft palate surgery although further studies including a larger patient population should determine whether dexamethasone is effective in controlling postoperative vomiting for this type of surgery.