This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Related letters  • Similar articles in JAMA  Topic Collections  • Otolaryngology/ Head & Neck Surgery  • Otolaryngology/ Head & Neck Surgery, Other  • Pediatrics  • Pediatrics, Other  • Statistics and Research Methods  • Surgery  • Surgical Physiology  • Blood/ Coagulation  • Drug Therapy  • Adverse Effects  • Hematology/ Hematologic Malignancies  • Hematology, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: The randomized trial by Dr Czarnetzki and colleagues¹ suggested that dexamethasone decreased the risk of PONV but was associated with an increased risk of postoperative bleeding. The authors speculated that postoperative bleeding might be related to inhibition of repair processes of surgical wounds by glucocorticoids.

Therapeutic doses of dexamethasone (0.04 mg/kg and 1.0 mg/kg twice daily for 2 days) can increase the level of von Willebrand factor antigen (a specific endothelial cell product and marker of injury).² There may be an inverse correlation between von Willebrand factor antigen levels and factor XIII (fibrin stabilizing factor), possibly due to consumption at the site of endothelial injury.³ Therefore, postoperative bleeding after dexamethasone treatment might be associated with decreased factor XIII levels, which have important roles in normal wound healing and hemostasis.

Although not studied in tonsillectomy, there have been reports of a possible relationship between the decrease of factor . . . [Full Text of this Article]

Jae Il Shin, MD
pedshin2000@yahoo.co.kr
Department of Pediatrics
Yonsei University College of Medicine
Seoul, South Korea

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Dexamethasone and Risk of Nausea and Vomiting and Postoperative Bleeding After Tonsillectomy in Children: A Randomized Trial
Christoph Czarnetzki, Nadia Elia, Christopher Lysakowski, Lionel Dumont, Basile N. Landis, Roland Giger, Pavel Dulguerov, Jules Desmeules, and Martin R. Tramèr
JAMA. 2008;300(22):2621-2630.
ABSTRACT | FULL TEXT  

RELATED LETTERS

Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children
Dirk Beutner and Caroline Koll
JAMA. 2009;301(17):1764.
EXTRACT | FULL TEXT  

Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children
Joel B. Gunter, J. Paul Willging, and Charles M. Myer, III
JAMA. 2009;301(17):1764-1765.
EXTRACT | FULL TEXT  

Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children—Reply
Christoph Czarnetzki, Nadia Elia, and Martin R. Tramèr
JAMA. 2009;301(17):1765-1766.
EXTRACT | FULL TEXT