The dexamethasone and midazolam combination decreases the incidence of postoperative vomiting in children undergoing adenotonsillectomy surgery under general anaesthesia

Luminiţa Chiuţu¹, Elena Ioniţă², Georgiana-DianaVărzaru1, Fl. Anghelina²
1. Clinica Anestezie şi Terapie Intensivă
2. Clinica ORL, Spitalul Clinic de Urgenţă, Craiova

Abstract

Background. Postoperative vomiting (POV) is a major cause of morbidity after tonsillectomy in children. Dexamethasone has a protective effect and it has been suggested that midazolam is also an effective agent.  The aim of the study was to evaluateof dexamethasone and midazolam would further increase the antivomiting effect.

Material and method. A group of 96 children undergoing tonsillectomy and adenoidectomy surgery, under general anesthesia, were enrolled in this randomized prospective study. The patients were divided into three groups: group A – 30 patients, who received intraoperatively 0.5 mg/kg dexamethasone, group B – 38 patients, who received 50 µg/kg midazolam and group C – 28 patients, who received both dexamethasone and midazolam intraoperatively. All received a standardized sevoflurane-fentanyl-muscle relaxant anaesthesia. The following parameters were evaluated: incidence of vomiting in 24 h, number of episodes and the use of rescue antiemetic, the time until the oral intake was restarted.

Results. The incidence of POV was greater in group B (31,57%) than in group A (16,66%). The group C had the lowest incidence of POV of 3,57% (p < 0,05 compared with group B). It was manifested as unique episode and was no need for rescue medication. The time to the first oral intake was significantly shorter in patients from the group C (p < 0.05 C vs A, p < 0.01 C vs B).

Conclusions. The dexamethasone/midazolam combination significantly decreases the incidence of POV and shortens the time to first oral intake in comparison with administration of dexamethasone or midazolam alone, in children undergoing tonsillectomy.

Keywords: dexamethasone, midazolam, postoperative vomiting, adenotonsillectomy