Splinter W M, Roberts D J
Department of Anaesthesia, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Anesth Analg. 1996 Nov;83(5):913-6. doi: 10.1097/00000539-199611000-00004.
We evaluated the effect of dexamethasone on vomiting after elective tonsillectomy in 133 healthy children aged 2-12 yr in a randomized, stratified, blocked, double-blind, placebo-controlled study. General anesthesia was induced by inhalation of N2O and halothane or intravenously (IV) with propofol. Anesthesia was maintained with N2O and halothane. Dexamethasone 150 micrograms/kg up to a maximum dose of 8 mg, or placebo, was administered IV before surgery. All patients received 1.5 mg/kg codeine intramuscularly (IM) intraoperatively. Perioperative IV fluids, management of emesis, postoperative pain and hospital discharge criteria were all standardized. The groups were similar with respect to number, age, weight, length of surgery, and estimated intraoperative blood loss. Dexamethasone reduced the overall incidence of vomiting from 72% (placebo) to 40% (P < 0.001). Vomiting, both in-hospital and postdischarge, was decreased by the prophylactic administration of dexamethasone. Each episode of in-hospital vomiting prolonged discharge by 13 +/- 2 min, mean +/- SD (P < 0.001). In conclusion, dexamethasone markedly decreased vomiting by healthy children after elective tonsillectomy in an ambulatory hospital setting.
在一项随机、分层、区组、双盲、安慰剂对照研究中，我们评估了地塞米松对133名2至12岁健康儿童择期扁桃体切除术后呕吐的影响。全身麻醉通过吸入笑气和氟烷或静脉注射丙泊酚诱导。麻醉维持使用笑气和氟烷。术前静脉注射地塞米松150微克/千克，最大剂量为8毫克，或注射安慰剂。所有患者术中均接受1.5毫克/千克可待因肌肉注射。围手术期静脉输液、呕吐处理、术后疼痛及出院标准均标准化。两组在人数、年龄、体重、手术时长及估计术中失血量方面相似。地塞米松将呕吐的总体发生率从72%（安慰剂组）降至40%（P<0.001）。预防性使用地塞米松可减少住院期间及出院后的呕吐。每次住院期间呕吐发作会使出院时间延长13±2分钟，均值±标准差（P<0.001）。总之，在门诊医院环境中，地塞米松显著减少了健康儿童择期扁桃体切除术后的呕吐。
