F. De Groote

Effect of dexamethasone on nausea, vomiting, and pain in paediatric tonsillectomy

BACKGROUND The efficacy of dexamethasone (DEX) to reduce morbidity after paediatric tonsillectomy remains controversial. We evaluated the effect of 0.15 and 0.5 mg kg(-1) DEX on the incidence of postoperative nausea and vomiting (PONV) and on pain intensity after paediatric tonsillectomy. METHODS A total of 147 children aged 2-8 yr undergoing elective tonsillectomy were included in this prospective randomized double-blind study. At the induction of anaesthesia, subjects received 0.15 mg kg(-1) (DEX 0.15), 0.5 mg kg(-1) (DEX 0.5) DEX, or an equivalent volume of saline solution (placebo). Anaesthetic and surgical techniques were standardized. The incidence of PONV and the need for anti-emetic drugs and additional analgesia (tramadol and/or morphine) were recorded. Postoperative pain was assessed using the Childrens Hospital of Eastern Ontario Pain Scale, the visual analogue scale, and the postoperative pain measure for parents. RESULTS The incidence of early PONV (primary outcome variable) was lower in both DEX groups (DEX 0.15: 21%; DEX 0.5: 22%; placebo: 49%; P=0.001). The incidence of severe pain was reduced in the DEX groups on the second postoperative day (DEX 0.15: 20%; DEX 0.5: 5%; placebo: 47%; P<0.001). The study was not powered to assess a difference between the two DEX dose groups. CONCLUSIONS A single i.v. injection of DEX at the induction of anaesthesia was effective in reducing the incidence of early and late PONV and the level of pain on the second postoperative day. A 0.15 mg kg(-1) DEX dose appeared to be as effective as a 0.5 mg kg(-1) dose to reduce the incidence of PONV.

Effects of dexamethasone on postoperative pain, nausea and vomiting in children undergoing tonsillectomy: A study of 2 doses: 0.15 and 0.5 mg/kg: 10AP1-6

Background and Goal of Study: Anti-emetic properties of dexamethasone (DXM) in children undergoing tonsillectomy are well recognized, but its effects on postoperative pain remains controversial (1). This prospective randomized double-blind study compared two dosages of DXM, 0.15 and 0.5 mg/kg to placebo on postoperative pain, nausea and vomiting (PONV) in children undergoing elective tonsillectomy Materials and Methods: Af ter local ethics commit tee approval and parental’s writ ten informed consent, 134 ASA I-II children aged 2-8 years were included in this study. They were randomized to receive intravenously (IV) at induction of anaesthesia either a saline solution (group P: N=44), DXM 0.15 mg/ kg (group DXM 0.15; N= 46) or DXM 0.5 mg/kg (group DXM 0.5; N= 44). Anaesthetic technique (fentanyl 2 μg/kg N2O-sevoflurane) and postoperative pain treatment (paracetamol -tramadol) were standardized. Incidence of early and delayed PONV, need for rescue anti emetics, analgesics consumption have been collected in the three groups. During the first postoperative day (POD1), pain was evaluated using the CHEOPS or the VAS according to the child’s age. On postoperative day 2 (POD2), incidence of PONV, and pain was assessed through a phone call. Pain was evaluated using the postoperative pain measure for parents (PPMP) (2). The three groups were compared using non parametric statistical tests or chisquare. A p< 0.5 was considered significant. Data are presented as median [interquartiles] or percentages Results and Discussion: There was no significant dif ference in demographic and surgical characteristics between the 3 groups.

EEG spectral entropy during sevoflurane anaesthesia in children: influence of age: 10AP1-3

entropy: SE) and frontal electromyogram (response entropy: RE) have been promoted as monitors of anaesthetic depth, but their characteristics in children remain poorly defined. This prospective randomized double-blind study assessed the effects of 50% N20 on SE and RE values during halothane and sevoflurane anaesthesia in children. Materials and Methods: Following institutional Ethics Committee approval and parental written informed consent, 40 ASA I and II children aged 6 months–5 years undergoing general anaesthesia for lower abdominal surgery were studied. Children were randomized to undergo halothane (group H: N 20) or sevoflurane (group S: N 20) All received caudal analgesia (bupivacaine 2 mg/kg) after anaesthetic induction. Entropy values were recorded by a blinded anaesthesiologist at 1 MAC steady state end tidal concentrations, in 50% O2/air and 50% O2/ N20 conditions. Data were compared with a paired Student t test. A p 0.05 was considered significant. Data are presented as mean SD. Results and Discussions: Demographic and surgical characteristics were not different among groups.