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Steroid After Tonsillectomy Increases Bleeding

Steroid After Tonsillectomy Increases Bleeding Children who were given the steroid dexamethasone after a tonsillectomy had less nausea and vomiting, but they also faced an increased risk of bleeding. According to a study, children will commonly feel postoperative nausea and vomiting in addition to pain and bleeding after the procedure. Despite clear information on dosing and side effects, researchers reported that dexamethasone is a standard practice at many institutions. Researchers believe that the increased bleeding with dexamethasone is due to impairment of wound healing.

Non-steroidal anti-inflammatory drugs have been used for pain relief but they also increase the risk of bleeding.

From Bio-Medicine:

“The clinical implication is that children undergoing [tonsillectomy] should not receive dexamethasone prophylactically unless an adequately designed, valid study has shown that our findings can be refuted,” said Dr. Martin R. Tramer, head of anesthesiology at Geneva University Hospitals in Switzerland.

Those taking the highest dose of dexamethasone had about seven times the risk of bleeding, the researchers reported.

In this trial, 215 children having elective tonsillectomies at a major teaching hospital in Switzerland were randomized to receive 0.05 milligrams per kilogram of dexamethasone, 0.15 mg/kg, 0.5 mg/kg, or a placebo.

But 4 percent of children in the placebo group and in the 0.15 mg/kg dexamethasone group experienced postoperative bleeding, compared to 11 percent of those taking the lowest dose of dexamethasone and 24 percent of those taking the highest dose.

One puzzling aspect of the findings is that the lower and higher doses of dexamethasone had higher levels of bleeding than the middle dose.

Bleeding is of particular concern after tonsillectomies because the wound is not sewn up or covered and is exposed to food, air and saliva. A large blood supply courses through the area and, if hemorrhaging occur, manual compression is next to impossible. That means surgery becomes the only option.

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