title: Subhypnotic propofol infusion plus dexamethasone is more effective than dexamethasone alone for the prevention of vomiting in children after tonsillectomy.
abstract: BACKGROUND
  Postoperative vomiting (POV) is a common complication after tonsillectomy. Dexamethasone is known to decrease postsurgical vomiting. In this study, we compared the effects of dexamethasone alone to dexamethasone plus propofol on postoperative vomiting in children undergoing tonsillectomy.
  
  
  METHODS
  In a randomized double-blinded study, we evaluated 80 healthy children, aged 4-12 years, who underwent tonsillectomy with or without adenoidectomy. After anesthesia was induced by inhalation of sevoflurane, 0.15 mg x kg(-1) dexamethasone and 2 microg x kg(-1) fentanyl was administered i.v. to all patients. The patients in the dexamethasone plus propofol group received 1 mg x kg(-1) propofol before intubation and continuously after intubation at a rate of 20 microg x kg(-1) x min(-1) until the surgery was completed. Data for postoperative vomiting were grouped into the following time periods: 0-4 and 4-24 h. Data were analyzed using a Student's t-test and chi-squared analysis.
  
  
  RESULTS
  The percentage of patients exhibiting a complete response (defined as no retching or vomiting for 24 h) increased from 37.5% in the dexamethasone-alone group to 75% in the dexamethasone plus propofol group (P = 0.001). Twenty-two patients (55%) in the dexamethasone-alone and nine patients (22.5%) in the dexamethasone plus propofol groups experienced vomited during 0-4 h (P = 0.003). Eight patients in the dexamethasone-alone group and three patients in the dexamethasone plus propofol group received ondansetron as a rescue antiemetic during the postoperative period.
  
  
  CONCLUSIONS
  For children undergoing tonsillectomy, intraoperative subhypnotic propofol infusion combined with dexamethasone treatment provides a better prophylaxis against postoperative vomiting than does dexamethasone alone.
authors.affiliation: Department of Anesthesiology and Reanimation, Medical Faculty, Ataturk University, Erzurum, Turkey. alifuat@atauni.edu.tr
authors.forename: Ali Fuat
authors.initials: AF
authors.lastname: Erdem
authors.forename: Ozgur
authors.initials: O
authors.lastname: Yoruk
authors.forename: Haci Ahmet
authors.initials: HA
authors.lastname: Alici
authors.forename: Mehmet
authors.initials: M
authors.lastname: Cesur
authors.forename: Canan
authors.initials: C
authors.lastname: Atalay
authors.forename: Enver
authors.initials: E
authors.lastname: Altas
authors.forename: Husnu
authors.initials: H
authors.lastname: Kursad
authors.forename: Mustafa Sahin
authors.initials: MS
authors.lastname: Yuksek