Abstract Objective: To determine whether the intravenous administration of dexamethasone sodium phosphate before tonsillectomy and adenoidectomy can reduce the morbidity from, and increase the safety of, this procedure. Design: Prospective, randomized, double-blind, placebocontrolled clinical trial. Setting: A university medical center, caring for both ambulatory and hospitalized children. Patients: Eighty children aged 3 to 15 years undergoing tonsillectomy and adenoidectomy for either chronic tonsillitis or adenotonsillar hypertrophy (obstructive sleep apnea and/or upper airway obstruction). Interventions: Forty-one children received intravenous dexamethasone sodium phosphate (1 mg/kg up to 16 mg) and 39 received placebo before undergoing an electrocautery dissection tonsillectomy and adenoidectomy. Main Outcome Measures: Postoperative oral intake, pain, vomiting, temperature, and complications. Results: Patients who received intravenous dexamethasone had significantly less trismus, vomiting, and elevations of temperature 6 hours after surgery and more oral intake (liquids and soft solids) at 24 hours. Three children, all of whom were in the placebo group, had emergency department visits for pain and dehydration. Each group had one child who had a secondary hemorrhage (no surgery needed), one child who had pneumonia, and one child who had night terrors. Conclusions: Treatment with intravenous dexamethasone before electrocautery tonsillectomy and adenoidectomy is safe, increases early postoperative oral intake, and decreases morbidity.(Arch Otolaryngol Head Neck Surg. 1996;122:117-120) References 1. Maniglia AJ, Kushner H, Cozzi L. Adenotonsillectomy: a safe outpatient procedure . Arch Otolaryngol Head Neck Surg . 1989;115:92-94.Crossref 2. Guida RA, Mattucci KF. Tonsillectomy and adenoidectomy: an inpatient or outpatient procedure? Laryngoscope . 1990;100:491-493.Crossref 3. Weimert TA, Babyak JW, Richter HJ. Electrodissection tonsillectomy . Arch Otolaryngol Head Neck Surg . 1990;116:186-188.Crossref 4. Linden BE, Gross CW, Long TE, Lazar RH. Morbidity in pediatric tonsillectomy . Laryngoscope . 1990;100:120-124.Crossref 5. Hawkins DB, Clark RW, Beneche JE. Corticosterioids in otolaryngology . In: Johnson JT, Derkay C, Mandell-Brown MK, Newman RK, eds. Instructional Courses . St Louis, Mo: Mosby–Year Book; 1991;4:185-200. 6. Haynes RC. Adrenocorticotrophic hormones: adrenocortical steroids and their synthetic analogs: inhibitors of the synthesis and actions of adrenocortical hormones . In: Gilman AG, Rall TW, Nies AS, Taylor P, eds. Pharmacological Basis of Therapeutics . 8th ed. Elmsford, NY: Pergamon Press Inc; 1990:1452. 7. Kuttner L, LePage T. Face scales for the assessment of pediatric pain: a critical review . Can J Behav Sci . 1989;21:198-209.Crossref 8. Bradley JV. Distribution-Free Statistical Tests . Englewood Cliffs, NJ: Prentice-Hall International Inc; 1968. 9. McColley SA, April MM, Carroll JL, Naclerio RM, Loughlin GM. Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea . Arch Otolaryngol Head Neck Surg . 1992;118:940-943.Crossref 10. David HA. Order Statistics . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981. 11. Volk MS, Martin P, Brodsky L, Stanievich JF, Ballou M. Effect of preoperative steroids on tonsillectomy patients . Otolaryngol Head Neck Surg . 1993;109: 726-730. 12. Hoffmann D. Use of steroids in otolaryngology . Ear Nose Throat J . 1988;67: 71-83. 13. Catlin FI, Grimes WJ. Effect of steroid therapy on recovery from tonsillectomy in children . Arch Otolaryngol Head Neck Surg . 1991;117:649-652.Crossref 14. Mann DG, St George C, Scheiner E, Granoff D, Imber P, Mlynarczyk FA. Tonsillectomy—some like it hot . Laryngoscope . 1984;94:677-679.Crossref 15. April MM, Naclerio RM. Complications of tonsillectomy and adenoidectomy . In: Eisele DW, ed. Complications in Head and Neck Surgery . 2nd ed. St Louis, Mo: Mosby–Year Book; 1993:262-266.
Archives of Otolaryngology - Head & Neck Surgery – American Medical Association
Published: Feb 1, 1996