King Adele, Elmaraghy Charles, Lind Meredith, Tobias Joseph D
Department of Anesthesiology, Royal Hospital for Children, Glasgow, UK.
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
J Anesth. 2020 Jun;34(3):445-452. doi: 10.1007/s00540-020-02758-y. Epub 2020 Mar 19.
Although one of the most commonly performed surgical procedures in children and frequently performed as outpatient surgery, the postoperative course following tonsillectomy may include nausea, vomiting, poor oral intake, and pain. These problems may last days into the postoperative course. Although opioids may be used to treat the pain, comorbid conditions such as obstructive sleep apnea may mandate limiting the dose and the frequency of administration. Adjunctive agents may improve the overall postoperative course of patients and limit the need for opioid analgesics. Dexamethasone is a frequently administered intraoperatively as an adjunctive agent to decrease inflammation and pain, limit the potential for postoperative nausea and vomiting, and improve the overall postoperative course. The following manuscript reviews the use of dexamethasone to improve outcomes following tonsillectomy or adenotonsillectomy, discusses the controversies regarding its potential association with perioperative bleeding, and investigates options for dosing regimens which may maintain the beneficial physiologic effects while limiting the potential for bleeding.
扁桃体切除术虽然是儿童中最常进行的外科手术之一，且常作为门诊手术进行，但术后过程可能包括恶心、呕吐、口腔摄入不足和疼痛。这些问题可能会持续数天。虽然阿片类药物可用于治疗疼痛，但诸如阻塞性睡眠呼吸暂停等合并症可能要求限制剂量和给药频率。辅助药物可能会改善患者的整体术后过程，并减少对阿片类镇痛药的需求。地塞米松是一种常用的术中辅助药物，可减轻炎症和疼痛，降低术后恶心和呕吐的可能性，并改善整体术后过程。以下手稿回顾了地塞米松在改善扁桃体切除术或腺样体扁桃体切除术后结局方面的应用，讨论了其与围手术期出血潜在关联的争议，并研究了给药方案的选择，这些方案可能在维持有益生理效应的同时限制出血可能性。
