Department of Anesthesiology, Centre-hospitalo-universitaire Brugmann, Free University of Brussels, 4 Place Van Gehuchten, B-1020 Brussels, Belgium.
Br J Anaesth. 2012 Sep;109(3):427-31. doi: 10.1093/bja/aes249.
The efficacy of dexamethasone (DEX) to reduce morbidity after paediatric tonsillectomy remains controversial. We evaluated the effect of 0.15 and 0.5 mg kg(-1) DEX on the incidence of postoperative nausea and vomiting (PONV) and on pain intensity after paediatric tonsillectomy.
A total of 147 children aged 2-8 yr undergoing elective tonsillectomy were included in this prospective randomized double-blind study. At the induction of anaesthesia, subjects received 0.15 mg kg(-1) (DEX 0.15), 0.5 mg kg(-1) (DEX 0.5) DEX, or an equivalent volume of saline solution (placebo). Anaesthetic and surgical techniques were standardized. The incidence of PONV and the need for anti-emetic drugs and additional analgesia (tramadol and/or morphine) were recorded. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale, the visual analogue scale, and the postoperative pain measure for parents.
The incidence of early PONV (primary outcome variable) was lower in both DEX groups (DEX 0.15: 21%; DEX 0.5: 22%; placebo: 49%; P=0.001). The incidence of severe pain was reduced in the DEX groups on the second postoperative day (DEX 0.15: 20%; DEX 0.5: 5%; placebo: 47%; P<0.001). The study was not powered to assess a difference between the two DEX dose groups.
A single i.v. injection of DEX at the induction of anaesthesia was effective in reducing the incidence of early and late PONV and the level of pain on the second postoperative day. A 0.15 mg kg(-1) DEX dose appeared to be as effective as a 0.5 mg kg(-1) dose to reduce the incidence of PONV.
地塞米松（DEX）减少小儿扁桃体切除术后发病率的疗效仍存在争议。我们评估了 0.15 和 0.5 mg/kg DEX 对小儿扁桃体切除术后恶心和呕吐（PONV）发生率和疼痛强度的影响。
本前瞻性随机双盲研究纳入了 147 名 2-8 岁择期行扁桃体切除术的儿童。在麻醉诱导时，患者接受 0.15mg/kg（DEX 0.15）、0.5mg/kg（DEX 0.5）DEX 或等体积生理盐水（安慰剂）。标准化了麻醉和手术技术。记录 PONV 的发生率以及止吐药和额外镇痛（曲马多和/或吗啡）的需求。使用安大略省儿童医院疼痛量表、视觉模拟评分和父母术后疼痛测量来评估术后疼痛。
早期 PONV（主要观察变量）的发生率在 DEX 组均较低（DEX 0.15：21%；DEX 0.5：22%；安慰剂：49%；P=0.001）。DEX 组在术后第 2 天的严重疼痛发生率降低（DEX 0.15：20%；DEX 0.5：5%；安慰剂：47%；P<0.001）。本研究没有足够的效力来评估两种 DEX 剂量组之间的差异。
麻醉诱导时单次静脉注射 DEX 可有效降低早期和晚期 PONV 的发生率以及术后第 2 天的疼痛水平。0.15mg/kg DEX 剂量似乎与 0.5mg/kg DEX 剂量一样有效，可降低 PONV 的发生率。
