THE EFFECT OF INTRAOPERATIVE DEXAMETHASONE ON THE IMMEDIATE AND DELAYED POSTOPERATIVE MORBIDITY IN CHILDREN UNDERGOING AMBULATORY ADENOTONSILLECTOMY

Abstract

S14 This prospective, double blind, placebo controlled study examined the effect of preoperative dexamethasone on post-operative nausea and vomiting (PONV) and 24 hr. recovery in 128 children undergoing ambulatory tonsillectomy. METHODS: With IRB approval and parental consent 128 children 2-12 yrs. of age, ASA physical status 1 and 2, participated. Each received oral midazolam 0.5-0.6 mg/kg (maximum dose 20 mg) preoperatively. Anesthesia was induced with halothane and nitrous oxide in 60% oxygen and was maintained with nitrous oxide and isoflurane. Intubation was facilitated by mivacurium 0.2 mg/kg. Each child received fentanyl 1[micro sign]g/kg IV before initiation of surgery. Dexamethasone 1 mg/kg, maximum dose 25 mg (steroid group) or placebo (saline group) was administered prior to initiation of surgery. Intraoperative fluids were standardized to 25-30 ml/kg of lactate Ringer's solution. RESULTS: Incidence of PONV, need for rescue antiemetic, quality of oral intake and analgesic requirements did not differ between the two groups prior to PACU discharge. However, during the 24 hour period following discharge from PACU, more patients in the saline group had PONV (62% vs 29%, respectively, p<0.05). Parental calls to the physician for complaints of pain, poor oral intake and/or PONV were also higher in the saline group. While none of the patients in the steroid group returned to hospital, 5 children in the saline group returned for management of PONV or IV hydration. Additionally, fewer children in the saline group had "good" to "excellent" oral intake compared to steroid group, (83% vs 58%, respectively, p<0.05) after home discharge. CONCLUSION: Preoperative administration of a single large dose of IV dexamethasone significantly decreased the overall incidence of PONV, [1,2] specifically during the 24 hours after home discharge in children undergoing ambulatory adenotonsillectomy. Preoperative dexamethasone also improved postoperative oral intake, reduced the number of phone calls from parents and prevented hospital returns for the management of PONV and poor oral intake during the 24 hours following home discharge. These benefits effects of dexamethasone, however, were not evident during early recovery. We propose that an antiemetic drug be added to minimize early PONV. However, further controlled studies are necessary to verify this proposal.