Perioperative dexamethasone administration and risk of bleeding following tonsillectomy in children: a randomized controlled trial

JAMA. 2012 Sep 26;308(12):1221-6. doi: 10.1001/2012.jama.11575.


Context: Corticosteroids are commonly given to children undergoing tonsillectomy to reduce postoperative nausea and vomiting; however, they might increase the risk of perioperative and postoperative hemorrhage.

Objective: To determine the effect of dexamethasone on bleeding following tonsillectomy in children.

Design, setting, and patients: A multicenter, prospective, randomized, double-blind, placebo-controlled study at 2 tertiary medical centers of 314 children aged 3 to 18 years undergoing tonsillectomy without a history of bleeding disorder or recent corticosteroid medication use and conducted between July 15, 2010, and December 20, 2011, with 14-day follow-up. We tested the hypothesis that dexamethasone would not result in 5% more bleeding events than placebo using a noninferiority statistical design.

Intervention: A single perioperative dose of dexamethasone (0.5 mg/kg; maximum dose, 20 mg), with an equivalent volume of 0.9% saline administered to the placebo group.

Main outcome measures: Rate and severity of posttonsillectomy hemorrhage in the 14-day postoperative period using a bleeding severity scale (level I, self-reported or parent-reported postoperative bleeding; level II, required inpatient admission for postoperative bleeding; or level III, required reoperation to control postoperative bleeding).

Results: One hundred fifty-seven children (median [interquartile range] age, 6 [4-8] years) were randomized into each study group, with 17 patients (10.8%) in the dexamethasone group and 13 patients (8.2%) in the placebo group reporting bleeding events. In an intention-to-treat analysis, the rates of level I bleeding were 7.0% (n = 11) in the dexamethasone group and 4.5% (n = 7) in the placebo group (difference, 2.6%; upper limit 97.5% CI, 7.7%; P for noninferiority = .17); rates of level II bleeding were 1.9% (n = 3) and 3.2% (n = 5), respectively (difference, -1.3%; upper limit 97.5% CI, 2.2%; P for noninferiority < .001); and rates of level III bleeding were 1.9% (n = 3) and 0.6% (n = 1), respectively (difference, 1.3%; upper limit 97.5% CI, 3.8%; P for noninferiority = .002).

Conclusions: Perioperative dexamethasone administered during pediatric tonsillectomy was not associated with excessive, clinically significant level II or III bleeding events based on not having crossed the noninferior threshold of 5%. Increased subjective (level I) bleeding events caused by dexamethasone could not be excluded because the noninferiority threshold was crossed.

Trial registration: Identifier: NCT01415583.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Antiemetics / adverse effects*
  • Antiemetics / therapeutic use
  • Child
  • Child, Preschool
  • Dexamethasone / adverse effects*
  • Dexamethasone / therapeutic use
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Perioperative Care*
  • Postoperative Hemorrhage / chemically induced*
  • Postoperative Nausea and Vomiting / prevention & control
  • Prospective Studies
  • Risk
  • Severity of Illness Index
  • Tonsillectomy*


  • Antiemetics
  • Dexamethasone

Associated data