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PEDIATRIC ANESTHESIA

Prophylactic Dexamethasone for Postoperative Nausea and Vomiting in Pediatric Strabismus Surgery: A Dose Ranging and Safety Evaluation Study

Rashmi Madan, MD^*, Anuj Bhatia, MD^*, Sajith Chakithandy, MBBS^*, Rajeshwari Subramaniam, MD^*, Gurram Rammohan, MBBS^*, Shrinivas Deshpande, MD^*, Manorama Singh, MD^*, and H. L. Kaul, MD^*

*Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India; Department of Anaesthetics, Queen Elizabeth Hospital, Norfolk; and Department of Anesthetics, Addenbrookes Hospital, Cambridge, United Kingdom

Address correspondence and reprint requests to Dr. Anuj Bhatia, Department of Anaesthetics, Addenbrooke’s Hospital, Hills Rd., Cambridge CB2 2QQ, UK. Address e-mail to bhatiaanuj{at}hotmail.com.

In this double-blind, randomized, placebo-controlled study, we evaluated the efficacy and safety of different doses of prophylactic IV dexamethasone for postoperative nausea and vomiting (PONV) in 168 children (aged 2–15 yr) scheduled for strabismus surgery. Patients received IV dexamethasone 0.25 mg/kg (D 0.25), 0.5 mg/kg (D 0.5), 1.0 mg/kg (D 1), or saline (S) immediately after induction of general anesthesia. Patients were discharged 24 h after surgery. Nausea and vomiting were assessed at 0–2, 2–6, and 6–24 h after surgery. Blood glucose was measured preoperatively and at 4 h after study drug administration. Wound healing and infection were assessed after 1 wk. More patients in group S had vomiting at 0–2, 2–6, and 6–24 h (P = 0.001, P = 0.003, and P = 0.04, respectively) and required larger doses of rescue antiemetics compared with the dexamethasone groups. Fewer patients in the dexamethasone groups (6, 3, and 6 in D 0.25, D 0.5, and D 1, respectively) had severe PONV compared with group S (P = 0.001). No significant increase in postoperative blood glucose levels was observed and wound healing was satisfactory in all four groups. The results suggest that dexamethasone 0.25 mg/kg is more effective than saline and equally effective compared with larger doses for preventing PONV for pediatric strabismus surgery.

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