Prophylactic dexamethasone for postoperative nausea and vomiting in pediatric strabismus surgery: a dose ranging and safety evaluation study.
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.
Madan
Rashmi
R
*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.
Bhatia
Anuj
A
Chakithandy
Sajith
S
Subramaniam
Rajeshwari
R
Rammohan
Gurram
G
Deshpande
Shrinivas
S
Singh
Manorama
M
Kaul
H L
HL
D000293:Adolescent; D000375:Aging / Q000502:physiology; D000768:Anesthesia, General; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D013285:Strabismus / Q000601:surgery*; D016896:Treatment Outcome
D000932:Antiemetics; D001786:Blood Glucose; D003907:Dexamethasone; D008787:Metoclopramide