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To the Editor: Dr Czarnetzki and colleagues¹ reported that the use of dexamethasone resulted in a dose-dependent decreased risk of postoperative nausea and vomiting (PONV) but was associated with an increased risk of bleeding following tonsillectomy. Because postoperative hemorrhage in patients undergoing tonsillectomy has the potential to be life threatening, extensive analysis of risk factors is of general interest.

Dexamethasone, a synthetic adrenocortical steroid, is a white, odorless, crystalline powder. It is stable in air and practically insoluble in water.² Because the authors administered dexamethasone intravenously, it is possible that dexamethasone sodium phosphate was used for injection. Additional components previously thought to be inactive could play important roles during postoperative bleeding. It would be helpful for the authors to provide more detailed pharmacological information about the administered drug to assess the conclusion drawn from this study.

Financial Disclosures: None reported.

Dirk Beutner, MD
dirk.beutner@uni-koeln.de
Department of Otorhinolaryngology, Head and Neck Surgery
University of Cologne
Cologne, Germany

Caroline Koll, MD
Department of Otorhinolaryngology, Head and Neck Surgery
University of Dusseldorf
Dusseldorf, Germany

1. Czarnetzki C, Elia N, Lysakowski C; et al. Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA. 2008;300(22):2621-2630. FREE FULL TEXT 2. McAllen MK, Langman MJ. A controlled trial of dexamethasone snuff in chronic perennial rhinitis. Lancet. 1969;1(7602):968-971. ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2009;301(17):1764.

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RELATED ARTICLE

Dexamethasone and Risk of Nausea and Vomiting and Postoperative Bleeding After Tonsillectomy in Children: A Randomized Trial
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JAMA. 2008;300(22):2621-2630.
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Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children
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Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children—Reply
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