Authors: Peterson MB, et al.
Pediatric Anesthesia. First published: September 8, 2025. doi:10.1111/pan.70046
This randomized controlled trial evaluated whether oral dexamethasone is a viable substitute for intravenous dexamethasone in preventing postoperative nausea and vomiting (PONV) in children undergoing tonsillectomy. The study was prompted by the 2020 shortage of intravenous dexamethasone due to its widespread use in COVID-19 treatment.
A total of 126 children aged 3–7 years were randomized to receive either oral or intravenous dexamethasone at 0.5 mg/kg (max dose 8 mg). PONV outcomes were assessed in the post-anesthesia care unit and during days 3–5 follow-up calls, with pain measured using the numeric pain scale or FLACC. Rates of PONV were low overall: nausea occurred in 2.4% and vomiting in 3.2% of patients receiving oral dexamethasone, while no immediate PONV was reported in the intravenous group. After discharge, PONV rates were similar between groups (40% oral vs 60% intravenous), showing no clinically meaningful difference.
What You Should Know:
Oral dexamethasone was found to be non-inferior to intravenous dexamethasone for PONV prevention in pediatric tonsillectomy patients. This suggests oral administration may be a safe and effective alternative, especially in times of drug shortages or when intravenous access is more challenging.
Clinical Relevance:
For anesthesiologists and perioperative teams, this trial provides evidence that oral dexamethasone can be substituted for intravenous dosing without compromising protection against PONV in young children after tonsillectomy. This flexibility may help ensure continuity of care when supply chain disruptions or clinical circumstances limit intravenous drug availability.
Thank you to Pediatric Anesthesia for allowing us to use this article.