Dexamethasone is often given after surgery to prevent postoperative nausea and vomiting in adults and children. In this study, children who underwent elective adenotonsillectomy at a Swiss hospital were randomized to receive either IV dexamethasone or placebo after induction of anesthesia: 54, 54, and 53 children received dexamethasone 0.05, 0.15, and 0.5 mg/kg, respectively, and 54 received a placebo. The study was terminated early because of a high number of postoperative bleeding episodes, and an interim analysis revealed that the increase was statistically significant in children who had received dexamethasone.

Dexamethasone significantly and dose-dependently decreased the incidence of nausea and vomiting 24 hours after surgery. Of the children given the placebo, 44% experienced nausea and vomiting, compared with 38%, 24%, and 12% of those who received dexamethasone 0.05, 0.15, and 0.5 mg/kg, respectively. Dexamethasone use also significantly decreased the need for ibuprofen within 24 hours of tonsillectomy.

Among the 207 children who were followed for 10 days after surgery (six were lost to follow-up), 22 experienced at least one hemorrhage within that time (except for one episode 20 days after surgery). Eight children needed emergency reoperation for bleeding. The highest dose of dexamethasone, 0.5 mg/kg, was associated with the greatest risk of bleeding, with 24% of that group experiencing at least one episode. In comparison, 11% and 4% of the children who received dexamethasone 0.05 or 0.15 mg/kg, respectively, had hemorrhage, and 4% of children in the placebo group experienced a bleeding episode.

Czarnetzki and colleagues suggest that dexamethasone may interfere with the healing of the surgical wound, increasing the risk of hemorrhage, and they recommend that the drug not be given to children who have undergone tonsillectomy.

Czarnetzki C. et al. JAMA 2008;300(22):2621-30.