Steroid Doses in Tonsillectomy Compared for Bleeding Risk

Dexamethasone not linked to dose-dependent hemorrhage risk in pediatric patients
By Jeff Muise
HealthDay Reporter

WEDNESDAY, Aug. 18 (HealthDay News) -- Giving the steroid dexamethasone to children undergoing tonsillectomy is not associated with a dose-dependent increased risk of postoperative hemorrhage, according to a review in the August issue of the Archives of Otolaryngology -- Head & Neck Surgery.

Matthew T. Brigger, M.D., of the Naval Medical Center San Diego, and colleagues reviewed data on 2,788 children and adolescents (ages 2 to 18) who underwent tonsillectomy, with or without adenoidectomy, and took perioperative dexamethasone (either 0.5 mg/kg or 1.0 mg/kg doses) during 2002 to 2009. Tonsillectomy techniques included extracapsular electrosurgical tonsillectomy, extracapsular radiofrequency ablation tonsillectomy, or intracapsular microdebrider tonsillotomy.

For the entire cohort, the researchers found that there were 104 instances of postoperative hemorrhage in 94 children. The odds ratio of postoperative hemorrhage of any severity in children who received the 1.0-mg/kg dose compared to those who received the 0.5-mg/kg dose was 0.66 after adjustment for age, sex, primary diagnosis, and surgical technique. Among those requiring rehospitalization, the adjusted odds ratio for the same comparison was 0.83 and, among those requiring surgical intervention, it was 0.71.

"Our large sample size, coupled with the generalizability of including all children undergoing tonsillectomy by two different surgeons during a seven-year period, provides no compelling evidence that perioperative dexamethasone administration confers any increased risk of postoperative hemorrhage," the authors write.

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