Featured Research

from universities, journals, and other organizations

Pre-op steroids to prevent nausea do not significantly increase post-op bleeding in tonsillectomy, study finds

Date:
September 25, 2012
Source:
Massachusetts Eye and Ear Infirmary
Summary:
Corticosteroids are often given to children undergoing tonsillectomy to reduce postoperative nausea and vomiting; however, previous research has suggested that corticosteroids may increase the risk of hemorrhage during and after surgery. Researchers set to determine the effect of dexamethasone, a corticosteroid, on bleeding. They found that administration of the dexamethasone to children during a tonsillectomy was not associated with excessive, serious bleeding events following surgery compared to patients who received placebo.

Tonsillectomy is exceedingly common, with a reported increase in tonsillectomy rates in children younger than 15 years from 287,000 to 530,000 per year over the past decade. Although safe, adenotonsillectomy can result in significant complications, such as aspiration and bleeding. Complications are infrequent, but because tonsillectomy is so common, the absolute number of children experiencing tonsillectomy complications is formidable.

Related Articles


Corticosteroids are often given to children undergoing tonsillectomy to reduce postoperative nausea and vomiting; however, previous research has suggested that corticosteroids may increase the risk of hemorrhage during and after surgery. Researchers from the Massachusetts Eye and Ear, Boston, Naval Medical Center Portsmouth, Virginia, and colleagues set to determine the effect of dexamethasone, a corticosteroid, on bleeding. They found that administration of the dexamethasone to children during a tonsillectomy was not associated with excessive, serious bleeding events following surgery compared to patients who received placebo. Their findings are reported in the September 26 issue of JAMA.

A recent randomized trial studying the dose response of perioperative dexamethasone to postoperative nausea and vomiting [PONV] in children undergoing tonsillectomy was prematurely terminated due to an increased risk of postoperative hemorrhage. The outcomes of the trial suggested that a single dose of intraoperative dexamethasone significantly increased post-tonsillectomy hemorrhage events. In light of these findings, there is a need to reassess the safety profile for dexamethasone when used during tonsillectomy," the authors write.

"This was a troubling study as it ran counter to our own American Academy of Otolaryngology, Head and Neck Surgery guidelines recommending steroids after tonsillectomy to reduce nausea and vomiting, as well as against the Cochrane Group data suggestions," said Senior Author Christopher Hartnick, M.D., co-director of Mass. Eye and Ear's Pediatric Airway/Swallowing/Voice Center and Harvard Medical School Associate Professor, Otology and Laryngology, "It went against the experience of a majority of practitioners who have routinely used steroids for years without finding an elevated bleeding rate. But the only way of testing this was through a randomized trial."

Dr. Hartnick, along with Thomas Q. Gallagher, M.C., U.S.N., of the Naval Medical Center Portsmouth, Va., and colleagues performed a clinical trial (NTC01415583) to examine bleeding events in children associated with dexamethasone use during tonsillectomy. The multicenter, randomized trial included 314 children ages 3 to 18 years undergoing tonsillectomy without a history of bleeding disorder or recent corticosteroid medication use. The study was conducted between July 2010 and December 2011 with 14-day follow-up. The researchers tested the hypothesis that dexamethasone would not result in 5 percent more bleeding events than placebo using a noninferiority (outcome not worse than treatment compared to) statistical design. Patients received a single perioperative dose of dexamethasone or an equivalent volume of saline.

The primary outcome measured was rate and severity of post-tonsillectomy hemorrhage in the 14-day postoperative period using a bleeding severity scale (level I, self-reported or parent-reported postoperative bleeding; level II, required inpatient admission for postoperative bleeding; or level III, required reoperation to control postoperative bleeding).

One hundred fifty-seven children (median [midpoint] age, 6 years) were randomized into each study group, with 17 patients (10.8 percent) in the dexamethasone group and 13 patients (8.2 percent) in the placebo group reporting bleeding events. The overall rate of bleeding events for all levels was 30 out of 314 (9.6 percent). The researchers found that in an intention-to-treat analysis, the rates of level I bleeding were 7.0 percent (n = 11) in the dexamethasone group and 4.5 percent (n = 7) in the placebo group; rates of level II bleeding were 1.9 percent (n = 3) and 3.2 percent (n = 5), respectively; and rates of level III bleeding were 1.9 percent (n = 3) and 0.6 percent (n = 1), respectively.

"The dexamethasone treatment failed to show noninferiority for the level I bleeding, but did demonstrate that the bleeding rate with dexamethasone is not more than 5 percent greater than that with placebo (noninferiority) for both level II and III bleeding events. The data was stratified for primary vs. secondary bleeding events and a decrease in level II and level III bleeding events in both groups was noted," the authors write.

"In conclusion, in this prospective, randomized study of 314 children undergoing tonsillectomy, perioperative dexamethasone administration was not associated with more level II or III bleeding events than placebo as shown by noninferiority. Increased subjective (level 1) bleeding events caused by dexamethasone could not be excluded because the noninferiority threshold of 5 percent was crossed," the authors write.


Story Source:

The above story is based on materials provided by Massachusetts Eye and Ear Infirmary. Note: Materials may be edited for content and length.


Journal Reference:

  1. Gallagher LQ, Hill C, Ojha S, et al. Perioperative Dexamethasone Administration and Risk of Bleeding Following Tonsillectomy in Children: A Randomized Controlled Trial. JAMA, 2012; 308 (12): 1221-1226 DOI: 10.1001/2012.jama.11575

Cite This Page:

Massachusetts Eye and Ear Infirmary. "Pre-op steroids to prevent nausea do not significantly increase post-op bleeding in tonsillectomy, study finds." ScienceDaily. ScienceDaily, 25 September 2012. <www.sciencedaily.com/releases/2012/09/120925171222.htm>.
Massachusetts Eye and Ear Infirmary. (2012, September 25). Pre-op steroids to prevent nausea do not significantly increase post-op bleeding in tonsillectomy, study finds. ScienceDaily. Retrieved October 25, 2014 from www.sciencedaily.com/releases/2012/09/120925171222.htm
Massachusetts Eye and Ear Infirmary. "Pre-op steroids to prevent nausea do not significantly increase post-op bleeding in tonsillectomy, study finds." ScienceDaily. www.sciencedaily.com/releases/2012/09/120925171222.htm (accessed October 25, 2014).

Share This



More Health & Medicine News

Saturday, October 25, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Texas Nurse Nina Pham Cured of Ebola

Texas Nurse Nina Pham Cured of Ebola

AFP (Oct. 25, 2014) — An American nurse who contracted Ebola while caring for a Liberian patient in Texas has been declared free of the virus and will leave the hospital. Duration: 01:01 Video provided by AFP
Powered by NewsLook.com
IKEA Desk Converts From Standing to Sitting With One Button

IKEA Desk Converts From Standing to Sitting With One Button

Buzz60 (Oct. 24, 2014) — IKEA is out with a new convertible desk that can convert from a sitting desk to a standing one with just the push of a button. Jen Markham explains. Video provided by Buzz60
Powered by NewsLook.com
Ebola Protective Suits Being Made in China

Ebola Protective Suits Being Made in China

AFP (Oct. 24, 2014) — A factory in China is busy making Ebola protective suits for healthcare workers and others fighting the spread of the virus. Duration: 00:38 Video provided by AFP
Powered by NewsLook.com
WHO: Millions of Ebola Vaccine Doses by 2015

WHO: Millions of Ebola Vaccine Doses by 2015

AP (Oct. 24, 2014) — The World Health Organization said on Friday that millions of doses of two experimental Ebola vaccines could be ready for use in 2015 and five more experimental vaccines would start being tested in March. (Oct. 24) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins