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PEDIATRIC ANESTHESIA

There Is No Dose-Escalation Response to Dexamethasone (0.0625–1.0 mg/kg) in Pediatric Tonsillectomy or Adenotonsillectomy Patients for Preventing Vomiting, Reducing Pain, Shortening Time to First Liquid Intake, or the Incidence of Voice Change

Michelle S. Kim, MD^*, Charles J. Coté, MD, Carmen Cristoloveanu, MD, Andrew G. Roth, MD, Polina Vornov, MD, Melissa A. Jennings, RN^*, John P. Maddalozzo, MD, and Cristine Sullivan, MBA, MS^||

From the *Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Anesthesia and Critical Care, Division of Pediatric Anesthesia, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatric Anesthesia, Division of Clinical Otolaryngology, ||The Mary Ann and J. Milburn Smith Child Health Research Program, Feinberg School of Medicine, Northwestern University, Children's Memorial Hospital, Chicago, Illinois.

Address correspondence and reprint requests to Michelle S. Kim, MD, Valley Anesthesiology Consultants, LTD 2901 N, Central Ave. Suite 500, Phoenix, AZ 85012. Address e-mail to mkimdoc{at}yahoo.com.

BACKGROUND: Tonsillectomy is associated with postoperative nausea and vomiting (PONV) if no prophylaxis is administered. Previous studies have shown that a single dose of dexamethasone decreases the incidence of PONV. The most effective dose of dexamethasone to affect clinical outcome is yet to be defined.

METHODS: One-hundred-twenty-five children were enrolled in a double-blind, prospective, randomized, dose-escalating study of dexamethasone: 0.0625, 0.125, 0.25, 0.5, or 1 mg/kg, maximum dose 24 mg. Nonparametric ANOVA was used to analyze the incidence of vomiting by treatment group for 0 to 5 h, >5 to 24 h. The Cox Proportional Likelihood Ratio Test was used to compare the time of first vomit and time to first pain medication across treatment groups.

RESULTS: There was no difference in the incidence of vomiting for the five escalating doses of dexamethasone in the time period. There were no differences in secondary outcomes (analgesic requirements, time to first liquid, and change in voice) across treatment groups.

CONCLUSION: We conclude that the lowest dose of dexamethasone (0.0625 mg/kg) was as effective as the highest dose of dexamethasone (1.0 mg/kg) for preventing PONV or reducing the incidence of other secondary outcomes following tonsillectomy or adenotonsillectomy. There is no justification for the use of high-dose dexamethasone for the prevention of PONV in this cohort of children.

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