A meta-analysis of dexamethasone use with tonsillectomy

Abstract

ABSTRACT

OBJECTIVE: To determine the quantitative impact of intravenous dexamethasone on recovery after ton-sillectomy using established principles for meta-analysis.

STUDY DESIGN/SETTING: Double-blind randomized-control trials in which subjects were treated identically except for the presence or absence of peri-operative intravenous dexamethasone. Six articles met inclusion criteria. Two investigators extracted data regarding postoperative emesis and return to a soft/regular diet.

RESULTS: Pooled analysis using a random effects model revealed a 27% decrease (P < 0.00001) in postoperative emesis attributable to dexamethasone (95% CI, 12% to 42%). Dexamethasone increased the tolerance of a soft/regular diet at 24 hours by 22% (P < 0.001), but studies were heterogenous with low precision (95% CI, 1% to 44%).

CONCLUSION: To prevent emesis in 1 child after tonsillectomy, approximately 4 children must receive perioperative dexamethasone. An additional benefit is earlier tolerance of a soft/regular diet, but low precision and heterogeneity among studies preclude definitive conclusions. SIGNIFICANCE: Perioperative dexamethasone administration had a positive impact on recovery from tonsillectomy.

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References

1. Vital and Health Statistics: Ambulatory and inpatient procedures in the United States, 1996. Series 13: Data From the National. Health Care Survey No. 139. US Department of Health and Human Services. Hyattsville, MD, November 1998, DHHS Publication No. (PHS) 99–1710; p. 13.

2. Rosenfeld

. How to systematically review the medical literature. Otolaryngol Head Neck Surg 1996; 115: 53–63.

3. April

Callan

Nowak

The effect of intravenous dexamethasone in pediatric adenotonsillectomy. Arch Otolaryngol Head Neck Surg 1996; 122: 117–20.

4. Catlin

Grimes

. The effect of steroid therapy on recovery from tonsillectomy in children. Arch Otolaryngol Head Neck Surg 1991; 117: 649–52.

5. Ohlms

Wilder

Weston

. Use of intraoperative cortico-steroids in pediatric tonsillectomy. Arch Otolaryngol Head Neck Surg 1995; 121: 737–42.

6. Pappas

Sukhani

Hotaling

The effect of preoperative dexamethasone on the immediate and delayed postoperative morbidity in children undergoing adenotonsillectomy. Anesth Analgesia 1998; 87: 57–61.

7. Splinter

Roberts

. Dexamethasone decreases vomiting by children after tonsillectomy. Anesth Analgesia 1996; 83: 913–6.

8. Tom

Templeton

Thompson

Dexamethasone in adenotonsillectomy. Int J Pediatr Otorhinolaryngol 1996; 37: 115–20.

9. Laupacis

Sackett

Roberts

. An assessment of clinically useful measures of the consequences of treatment. N Engl J Med 1988; 318: 1728–33.

10.

10. Der Simonian

Laird

. Meta-analysis in clinical trials. Control Ciin Trials 1986; 7: 177–88.

11.

11. Gustafson

. TRUE EPISTAT Reference Manual, 5th ed. Richardson, TX: Epistat Services; 1994.

12.

12. Volk

Martin

Brodsky

The effects of preoperative steroids on tonsillectomy patients. Otolaryngol Head Neck Surg 1993; 109: 726–30.