title: The steroid controversy: where are we?
abstract: Dexamethasone is widely administered to children during elective tonsillectomy to reduce the rate of postoperative nausea and vomiting, as well as decrease postoperative use of pain medications. Over the past two decades, there has been a wealth of literature advocating the practice that has led to endorsement by a variety of anesthesia and otolaryngology professional associations. However, the publication of a trial that was halted due to a potential dose-dependent association between postoperative hemorrhage and dexamethasone raised significant scrutiny regarding the practice in 2008. As a result, significant re-evaluation of existing data as well as the development and execution of additional trials have been pursued in recent years. Ultimately, the body of evidence that currently exists appears to support the concept that a single dose of perioperative dexamethasone is not associated with undue risk. A decision to withdraw dexamethasone from use in pediatric tonsillectomy needs to be weighed against the potential of causing increased postoperative nausea, vomiting, pain, and resultant hospital readmission. At this point, surgeons and anesthesiologists should feel comfortable giving perioperative dexamethasone but must remain vigilant for bleeding complications.
authors: Department of Otolaryngology, Head and Neck Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA.
authors: Matthew
authors: M
authors: Keller
authors: Matthew T
authors: MT
authors: Brigger
mesh_terms: D002648:Child; D003907:Dexamethasone / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D014068:Tonsillectomy / Q000009:adverse effects*
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone