Prophylactic Dexamethasone for Postoperative Nausea and Vomiting in Pediatric Strabismus Surgery: A Dose Ranging and Safety Evaluation Study Rashmi Madan, MD*†, Anuj Bhatia, MD*‡, Sajith Chakithandy, MBBS*, Rajeshwari Subramaniam, MD*, Gurram Rammohan, MBBS*, Shrinivas Deshpande, MD*, Manorama Singh, MD*, and H. L. Kaul, MD* *Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India; †Department of Anaesthetics, Queen Elizabeth Hospital, Norfolk; and ‡Department of Anesthetics, Addenbrookes Hospital, Cambridge, United Kingdom In this double-blind, randomized, placebo-controlled study, we evaluated the efficacy and safety of different doses of prophylactic IV dexamethasone for postopera- tive nausea and vomiting (PONV) in 168 children (aged 2–15 yr) scheduled for strabismus surgery. Patients re- ceived IV dexamethasone 0.25 mg/kg (D 0.25), 0.5 mg/kg (D 0.5), 1.0 mg/kg (D 1), or saline (S) imme- diately after induction of general anesthesia. Patients were discharged 24 h after surgery. Nausea and vomit- ing were assessed at 0 –2, 2– 6, and 6 –24 h after surgery. Blood glucose was measured preoperatively and at 4 h after study drug administration. Wound healing and infection were assessed after 1 wk. More patients in group S had vomiting at 0 –2, 2– 6, and 6 –24 h (P = 0.001, P = 0.003, and P = 0.04, respectively) and required larger doses of rescue antiemetics compared with the dexamethasone groups. Fewer patients in the dexa- methasone groups (6, 3, and 6 in D 0.25, D 0.5, and D 1, respectively) had severe PONV compared with group S (P = 0.001). No significant increase in postoperative blood glucose levels was observed and wound healing was satisfactory in all four groups. The results suggest that dexamethasone 0.25 mg/kg is more effective than saline and equally effective compared with larger doses for preventing PONV for pediatric strabismus surgery. (Anesth Analg 2005;100:1622–6) P ediatric strabismus surgery is associated with fre- quent early and late postoperative nausea and vomiting (PONV) (1). An antiemetic is routinely recommended for these patients but there is no consen- sus on either the choice or the optimal dose of the anti- emetic (2). Dexamethasone, in large doses (1 mg/kg), is a cost-effective alternative to ondansetron in signifi- cantly reducing the incidence of PONV in pediatric pa- tients undergoing strabismus surgery (3). Prophylactic dexamethasone in doses of 0.15– 0.5 mg/kg has been found to be an effective antiemetic drug for children undergoing tonsillectomy and strabismus surgery (4 – 6). The efficacy of different doses of dexamethasone in children undergoing strabismus surgery has not been evaluated. This randomized, double-blind, placebo-controlled study was designed to evaluate the effect of different doses of prophylactic dexa- methasone for prevention of PONV in pediatric pa- tients undergoing strabismus surgery. Suspected side effects associated with the use of dexametha- sone such as hyperglycemia, wound infection, and delayed wound healing were also studied. Methods After obtaining approval from the IRB and informed written consent from guardians, the study was con- ducted on 168 ASA physical status I–II children be- tween the ages of 2 and 15 yr scheduled for elective strabismus repair under general anesthesia. Children who had a history of PONV and motion sickness or had received drugs known to have antiemetic effects (phenothiazines, scopolamine, corticosteroids, and tri- cyclic antidepressants) in the 24 h before surgery were excluded from the study. All children fasted for at least 6 h before surgery for solids but clear fluids were allowed until 3 h before anesthetic induction. Accepted for publication November 3, 2004. Address correspondence and reprint requests to Dr. Anuj Bhatia, Department of Anaesthetics, Addenbrooke’s Hospital, Hills Rd., Cam- bridge CB2 2QQ, UK. Address e-mail to bhatiaanuj@hotmail.com. DOI: 10.1213/01.ANE.0000150977.14607.E1 ©2005 by the International Anesthesia Research Society 1622 Anesth Analg 2005;100:1622–6 0003-2999/05