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| |  Intraoperative Dexamethasone Does Not increase Risk of Secondary Post-Tonsillectomy Haemorrhage: Presented at AAO-HNSF By Kristina Rebelo SAN DIEGO -- October 7, 2009 -- The use of intraoperative dexamethasone does not appear to increase the risk of secondary post-tonsillectomy haemorrhage (SPTH) in children, according to a study presented here at the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting 2009. A study published in 2008 found that dexamethasone 0.5 mg/kg was associated with a higher bleeding risk.(1) However, this current study based on 333 children with a mean age of 7 years had contrary findings. “If you look at the active debate that has been going on in JAMA, they suggest dexamethasone increased the risk of haemorrhage, but in looking over this from our cohort, this study found that there was not an increase in risk,” Muhammad Shakeel, Department of Otolaryngology Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, told DocGuide on October 5. “So based on our data, there is no reason to change the practice of using intraoperative dexamethasone.” The researchers’ method revealed that a review was performed retrospectively on a random sample of children undergoing tonsillectomy +- adenoidectomy during the 2004-2006 time period at a tertiary London hospital with equal gender distribution. Patients were divided into 2 groups: group A (n = 277) did not receive intraoperative dexamethasone and group B (n = 56) did. Standard cold steel and harmonic scalpel techniques were used in 49.5% and 43.2 % of patients respectively. Study results reported that there were 33 episodes of SPTH in 32 children receiving intraoperative dexamethasone compared with 28 of 277 not receiving dexamethasone. In order to control bleeding in 6 of the children who did not receive the dexamethasone, a general anaesthetic was required. Overall, the use of dexamethasone was not associated with an increased risk of SPTH (relative risk, 0.88; 95% confidence interval, 0.36-2.19). “Since dexamethasone significantly reduces postoperative vomiting, we suggest more studies from different centres look at this association between postoperative bleeding and dexamethasone in further detail,” Dr. Shakeel urged. 1. Czarnetzki C et al. JAMA. 2008;300:2621-2630. [Presentation title: Dexamethasone and Secondary Post-Tonsillectomy Hemorrhage. Abstract SP370]
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