The effect of dexamethasone on the incidence of laryngospasm in pediatric patients after the Tonsillectomy

Background and aims: Laryngospasm and vomiting occurring in children after tracheal extubation might be dangerous. The aim of this study was to evaluate the effects of preoperative 0.5 mg/kg intravascular (IV) of dexamethasone on the incidence of post extubation laryngospasm, and vomiting in children after the tonsillectomy. Methods: This study was performed at Ilam Imam Khomeini hospital in 2009. In a randomized double-blind controlled trial, 66 pediatric patients, 4-12 years old were randomly assigned in two equal groups: treatment group (Dexamethasone, 0.5mg/kg IV) and placebo (saline) group, after the induction of anesthesia before the surgery. Surgery and anesthesia were the same in 2 groups. Children who received steroids, antihistaminics, or phychoactive drugs within 24 h before the surgery were excluded from the study. Children with IV induction or steroid administration, with diabetes and mental retardation were not included in the study. The incidence of post-extubation laryngospasm and vomiting was recorded by the investigator. Results: The mean of age of Dexamethasone and placebo groups were 6.4±2.2 and 6.1±2.8 year, respectively. Furthermore, the mean weight of Dexamethasone and control groups were 19.2±5.3 and 20.3±6.8 kg, respectively (P>0.05). In addition, while the mean anesthesia duration in dexamethasone group was 57.4±7.4 minutes, in placebo group it was 55.6±4.6 minutes. The mean of surgery duration of dexamethasone and placebo groups were 40.7±6.7 and 42.3±8.4 minutes, respectively (P>0.05). Moreover, the incidence of post-extubation laryngospasm in dexamethasone group (6%) was lower than in the placebo group (30%) (P<0.05). Finally, the incidence of vomiting in dexamethasone group (18%) was significantly lower than the placebo group (51.5%) (P<0.05). Conclusion: In the pediatric patients undergoing tonsillectomy, using preoperative dexamethasone could significantly reduce the post-extubation laryngospasm, without any significant side effect, so it is recommended for routine usage.