Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis

被引:45
作者
Bellis, J. R. [1 ]
Pirmohamed, M. [4 ]
Nunn, A. J. [3 ]
Loke, Y. K. [5 ]
De, S. [2 ]
Golder, S. [6 ]
Kirkham, J. J. [7 ]
机构
[1] Univ Liverpool, Alder Hey Childrens NHS Fdn Trust, Liverpool L12 2AP, Merseyside, England
[2] Univ Liverpool, Alder Hey Childrens NHS Fdn Trust, Inst Translat Med Child Hlth, Dept Paediat Otolaryngol Head & Neck Surg, Liverpool L12 2AP, Merseyside, England
[3] Univ Liverpool, Alder Hey Childrens NHS Fdn Trust, Inst Translat Med Child Hlth, Dept Womens & Childrens Hlth, Liverpool L12 2AP, Merseyside, England
[4] Univ Liverpool, Dept Mol & Clin Pharmacol, Liverpool L69 3GE, Merseyside, England
[5] Univ E Anglia, Fac Med & Hlth Sci, Norwich Med Sch, Norwich NR4 7TJ, Norfolk, England
[6] Univ York, Ctr Reviews & Disseminat, York YO10 5DD, N Yorkshire, England
[7] Univ Liverpool, Dept Biostat, Liverpool L69 3GS, Merseyside, England
关键词
dexamethasone; paediatrics; tonsillectomy; POST-TONSILLECTOMY; POSTOPERATIVE NAUSEA; ORAL INTAKE; PREOPERATIVE DEXAMETHASONE; INTRAVENOUS DEXAMETHASONE; AMBULATORY TONSILLECTOMY; PLUS DEXAMETHASONE; CHILDREN; PAIN; MORBIDITY;
D O I
10.1093/bja/aeu152
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
In children undergoing tonsillectomy, dexamethasone is recommended to reduce the risk of postoperative nausea and vomiting while non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain relief. We aimed to determine whether children who receive dexamethasone or dexamethasone with NSAID are more likely to experience haemorrhage post-tonsillectomy. Randomized and non-randomized studies in which children undergoing tonsillectomy received dexamethasone or dexamethasone and NSAID were sought within bibliographic databases and selected tertiary sources. The risk of bias assessment and evaluation of haemorrhage rate data collection and reporting were assessed using the Cochrane Risk of Bias Tool and McHarm tool. Synthesis methods comprised pooled estimate of the effect of dexamethasone on the risk of haemorrhage rate using the Peto odds ratio (OR) method. The pooled estimate for haemorrhage rate in children who received dexamethasone was 6.2%, OR 1.41 (95% confidence interval 0.89-2.25, P=0.15). There was risk of bias and inconsistent data collection and reporting rates of haemorrhage in many of the included studies. Clinical heterogeneity was observed between studies. The pooled analysis did not demonstrate a statistically significant increase in the risk of post-tonsillectomy haemorrhage with dexannethasone with/without NSAID use in children. However, the majority of the included studies were not designed to investigate this endpoint, and thus large studies which are specifically designed to collect data on haemorrhage rate are needed.
引用
收藏
页码:23 / 42
页数:20
相关论文
共 94 条
[1]   Dexamethasone and Postoperative Bleeding Risk After Adenotonsillectomy in Children [J].
Ahmed, Kamran A. ;
Dreher, Mary Ellen ;
King, Rebecca F. ;
Flick, Randall ;
Marienau, Mary E. S. ;
Schears, Gregory J. ;
Orvidas, Laura J. .
LARYNGOSCOPE, 2011, 121 (05) :1060-1061
[2]  
Al-Shehri AM, 2007, CURRENT PEDIAT RES, V11, P3
[3]  
Alajmi MA, 2008, KUWAIT MED J, V40, P211
[4]  
[Anonymous], 2009, GUID PREV POST VOM C
[5]  
[Anonymous], KOREAN J OTOLARYNGOL
[6]  
[Anonymous], J BAHRAIN MED SOC
[7]   The effect of dexamethasone on postoperative vomiting after tonsillectomy [J].
Aouad, MT ;
Siddik, SS ;
Rizk, LB ;
Zaytoun, GM ;
Baraka, AS .
ANESTHESIA AND ANALGESIA, 2001, 92 (03) :636-640
[8]  
April MM, 1996, ARCH OTOLARYNGOL, V122, P117
[9]   A significant reduction in paediatric post-tonsillectomy vomiting through audit [J].
Bennett, A. M. D. ;
Emery, P. J. .
ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, 2008, 90 (03) :226-230
[10]   Ambulatory powered intracapsular tonsillectomy and adenoidectomy in children younger than 3 years [J].
Bent, JP ;
April, MM ;
Ward, RF ;
Sorin, A ;
Reilly, B ;
Weiss, G .
ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY, 2004, 130 (10) :1197-1200