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Dexamethasone Reduces Postoperative Nausea in Pediatric Upper Endoscopy with Deep Sedation

A Randomized Controlled Trial

Moheimani, Hamed*; Yaseri, Mehdi

Journal of Pediatric Gastroenterology and Nutrition: May 18, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002398
Clinical Trials: Gastroenterology: PDF Only
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Objectives: We aimed to evaluate the effect of a single dose of pre-operative dexamethasone on postoperative nausea and vomiting (PONV), a frequent complication and a major cause of delayed recovery in pediatric upper gastrointestinal endoscopy (UGIE) under sedation.

Methods: In this double-blind randomized controlled study, 98 children aged 2-14, with ASA status I-II, and undergoing elective UGIE with deep sedation were included and randomly assigned to two groups. Pre-operatively, after anesthesia induction with sodium thiopental and maintenance with sevoflurane, patients in the intervention (n = 49) and control (n = 49) groups respectively received 0.1 mg kg-1 i.v. dexamethasone and 2cc i.v. 0.9% saline. Postoperatively, PONV incidence was measured as the primary outcome.

Results: PONV incidence was significantly less in dexamethasone group (8.2%) compared to the control group (26.5%), (difference = 18.3%, 95% CI: 3.4% to 33%, P = 0.016). For secondary outcomes, between-group differences were not statistically significant: incidence of bronchospasm or laryngospasm (both 4.1%, P = 1); Emergence delirium assessed with PAED scale (5.9 ± 3.4 vs. 5.7 ± 3.2, P = 0.751); Modified Aldrete score at 0 minutes (9.4 ± 0.8 vs. 9.3 ± 0.9, P = 0.909) and at 5 minutes (9.5 ± 0.7 vs. 9.4 ± 0.9, P = 0.527); and recovery time (21.1 ± 6.6 vs. 23.4 ± 8.6 minutes, P = 0.130).

Conclusion: A single pre-operative dose of i.v. dexamethasone reduces PONV in children undergoing elective UGIE with deep sedation, but has no significant effect on the patient recovery time or the incidence of postoperative bronchospasm or laryngospasm and emergence delirium.

*Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Address correspondence and reprint requests to Dr. Hamed Moheimani, Number 11, Valadi st., Hafez st., Karimkhan st., 1593919654, Tehran, Iran (e-mail: h-moheimani@alumnus.tums.ac.ir).

Received 12 February, 2019

Accepted 24 April, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

Financial Support: This work was conducted as a student research project supported by the office of Vice-chancellor for Research, Tehran University of Medical Sciences, Tehran, Iran.

Conflicts of Interest: None declared.

Clinical Trial Registration Number IRCT20180929041173N1 at irct.ir

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,