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In Reply: Drs Beutner and Koll ask for more details concerning the dexamethasone formulation that we used in our randomized trial. Our dexamethasone sodium phosphate solution also contained propylene glycol, edetic acid disodium salt, sodium chloride, and water. Of those, only edetic acid disodium salt (used as an antioxidant for many intravenous drug formulations) may theoretically have an effect on coagulation when used in very high doses.¹ However, considering the minimal concentration of this substance when used as an additive, an increased bleeding risk is highly unlikely. A fatal case due to the chelating properties of edetic acid disodium salt with subsequent hypocalcemia has been described.²

Dr Shin draws attention to another potential biological basis that may explain an increased bleeding risk associated with dexamethasone in surgical patients. The dexamethasone-related increase in von Willebrand factor antigen and its potential negative effect on factor XIII warrants further investigation.

Dr Gunter and . . . [Full Text of this Article]

Christoph Czarnetzki, MD, MBA
christoph.czarnetzki@hcuge.ch
Division of Anesthesiology
Geneva University Hospitals
Geneva, Switzerland

Nadia Elia, MD, MSc
Faculty of Medicine
Geneva University
Geneva

Martin R. Tramèr, MD, DPhil
Division of Anesthesiology
Geneva University Hospitals

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Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children
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