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Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children

Dirk Beutner, MD; Caroline Koll, MD
JAMA. 2009;301(17):1764-1766. doi:10.1001/jama.2009.573
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To the Editor: Dr Czarnetzki and colleagues1 reported that the use of dexamethasone resulted in a dose-dependent decreased risk of postoperative nausea and vomiting (PONV) but was associated with an increased risk of bleeding following tonsillectomy. Because postoperative hemorrhage in patients undergoing tonsillectomy has the potential to be life threatening, extensive analysis of risk factors is of general interest.

Dexamethasone, a synthetic adrenocortical steroid, is a white, odorless, crystalline powder. It is stable in air and practically insoluble in water.2 Because the authors administered dexamethasone intravenously, it is possible that dexamethasone sodium phosphate was used for injection. Additional components previously thought to be inactive could play important roles during postoperative bleeding. It would be helpful for the authors to provide more detailed pharmacological information about the administered drug to assess the conclusion drawn from this study.

AUTHOR INFORMATION

Financial Disclosures: None reported.

REFERENCES

Czarnetzki C, Elia N, Lysakowski C,  et al.  Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial.  JAMA. 2008;300(22):2621-2630
PubMedCrossRef
McAllen MK, Langman MJ. A controlled trial of dexamethasone snuff in chronic perennial rhinitis.  Lancet. 1969;1(7602):968-971
PubMedCrossRef

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Czarnetzki C, Elia N, Lysakowski C,  et al.  Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial.  JAMA. 2008;300(22):2621-2630
PubMedCrossRef
McAllen MK, Langman MJ. A controlled trial of dexamethasone snuff in chronic perennial rhinitis.  Lancet. 1969;1(7602):968-971
PubMedCrossRef
May 6, 2009
Jae Il Shin, MD
JAMA. 2009;301(17):1764-1766.
May 6, 2009
Joel B. Gunter, MD; J. Paul Willging, MD; Charles M. Myer, MD
JAMA. 2009;301(17):1764-1766.
May 6, 2009
Christoph Czarnetzki, MD, MBA; Nadia Elia, MD, MSc; Martin R. Tramèr, MD, DPhil
JAMA. 2009;301(17):1764-1766.
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