Dexamethasone-low dose ketamine combination versus droperidol low dose ketamine. A comparative study for their effect on postoperative nausea and vomiting and swallowing evoked pain after paediatric adenotonsillectomy

40 children aged [6 - 12] years ASA 1 and II scheduled for Adenotonsillectomy were randomly allocated to receive either ketamine [0.1 mg/ kg] IM 15 minutes before induction of anesthesia and dexamethasone [150 micro g/ kg] before the end of surgery [group I] or ketamine [0.1 mg/ kg] IM 15 minutes before induction plus droperidol 15 micro g/ kg before the end of surgery [group II]. General anesthesia was standardized for both groups where all children were given rectal diclofenac [2 mg/ kg] 20 minutes before end of surgery. Thiopental 5 mg/ kg was used as an induction agent and suxamethonium [1 mg/ kg] was used to facilitate tracheal intubation. Anesthesia was maintained with halothane 1-2% concentration supplemented with oxygen -nitrous oxide [40-60%] After the end of surgery, all children were transferred to post anesthesia care unit where a trained nurse blinded to the study observed [and after that in the ward] observed all episodes of nausea and vomiting during the first 24 hours. Also pain scores were assessed 1/2 hour, 1,2 and 3 hours after extubation and remaining of the first postoperative day. Time for first call analgesia, first oral intake and first adequate oral intake were observed during the first postoperative day. All episodes of postoperative nausea and vomiting were significantly lower in group I; pain scores were significantly lower in group I at all times compared to group II. Time for first call of analgesia was significantly longer in group 1 and time of oral intake and adequate oral intake were significantly shorter in group I compared to group II. We concluded that ketamine [0.1 mg/ kg] + dexamethasone [150 micro g/ kg] combination gave significant better results than [ketamine [0.1 mg] + droperidol combination as regards PONOV and pain relief during the first postoperative day in children undergoing elective adenotonsillectomy done on ambulatory basis

Oral prednisolone or dexamethasone, which one to be prefered for preventing relapse of acute asthma exacerbations in childhood?

In this prospective, randomized, clinical trial, 68 asthmatic patients, between 6 and 12 years were followed-up for 2 weeks after their acute exacerbation had been stabilized by the standard acute asthma treatment protocol. They were assigned to receive either 2 mg / kg / day of prednisolone divided on 3 doses for 5 days [PRED group], or 0.5 mg / kg / day of dexamethasone as a single morning dose for 3 days [DEX group]. The primary outcome measure was the rate of relapse within the follow-up period assessed by a Peak Expiratory Flow Rate [PEFR] < 70% of the predicted value, and a clinical asthma severity score more than 3. The secondary outcome measures included persistence of symptoms, quality of life, medication use, and adverse effects. There was no significant difference in relapse rates between the two groups [13.3% For PRED group and 15.2% for DEX group, P= 0.87].Compliance to medication was significantly higher in DEX group compared with PRED group[P= 0.04], and more children vomited their medication in the PRED group than in DEX group, but the difference was non-significant [P=0.32]. There was no significant difference between the two groups in the prevalence of persistent symptoms, quality of life, or adverse effects other than vomiting at the time of follow - up [P< 0.05]. We concluded that dexamethasone was as effective as prednisolone, with better compliance and less adverse effects, for preventing relapse of acute asthma exacerbations in childhood