Premium
Do Steroids Reduce Morbidity of Tonsillectomy? Meta‐Analysis of Randomized Trials
Author(s) -
Steward David L.,
Welge Jeffrey A.,
Myer Charles M.
Publication year - 2001
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200110000-00008
Subject(s) - tonsillectomy , medicine , placebo , relative risk , dexamethasone , confidence interval , meta analysis , randomized controlled trial , dosing , anesthesia , absolute risk reduction , clinical endpoint , surgery , alternative medicine , pathology
Objectives/Hypothesis The study aims to reconcile conflicting published reports regarding the clinical efficacy of a single intraoperative dose of dexamethasone in reducing post‐tonsillectomy morbidity. Study Design Systematic overview (meta‐analysis). Methods To critically evaluate the existing evidence, we performed a formal meta‐analysis of eight double‐blinded, randomized, placebo‐controlled studies of dexamethasone in pediatric patients undergoing tonsillectomy or adenotonsillectomy. Reduction in postoperative emesis and pain, as well as early return to soft or solid diet, were studied as distinct end points. Results Children being given a single intraoperative dose of dexamethasone (dosing, 0.15–1.0 mg/kg; maximum dose, 8–25 mg) were two times less likely to vomit in the first 24 hours than children being given placebo (relative risk [RR] = 0.55; 95% confidence interval [CI], 0.41–0.74; P <.0001). Routine use in four children would be expected to result in one less patient having post‐tonsillectomy emesis (risk difference [RD] = −0.24; 95% CI, −0.38 to −0.10; P = .0006). In addition, children being given dexamethasone were more likely to advance to a soft or solid diet on post‐tonsillectomy day 1 (RR = 1.69; 95% CI, 1.02–2.79; P = .04) than those being given placebo. Because of missing data and varied outcome measures, pain could not be meaningfully analyzed as a distinct end point. Conclusion Given the frequency of tonsillectomy, relative safety and low cost of dexamethasone, and the reduction in postoperative morbidity, we recommend routine use of a single intravenous dose during pediatric tonsillectomy.