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Steroide zur Reduktion der Morbidität nach Tonsillektomie

Steroids for reduction of morbidity following tonsillectomy

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Zusammenfassung

Hintergrund

Übelkeit, Erbrechen, Schmerzen und verzögerte Nahrungsaufnahme kennzeichnen im Wesentlichen die Morbidität nach Tonsillektomie. Neben verschiedenen anderen Maßnahmen ist es in der Vergangenheit gelungen, die postoperative Morbidität durch Steroidgabe positiv zu beeinflussen.

Patienten und Methoden

Die Allgemeingültigkeit von Empfehlungen zur Steroidgabe nach Tonsillektomie soll mittels Literaturrecherche überprüft werden. Ausgeschlossen sind Studien, in denen Steroide mit anderen Medikamenten zur Reduzierung der postoperativen Morbidität verglichen wurden.

Ergebnisse

Die insgesamt 31 Studien sind hinsichtlich Altersverteilung, Operationsmethoden, Nachbeobachtungszeit und Anästhesieverfahren sehr heterogen und nicht frei von Einflussfaktoren. Zwei Drittel der Untersuchungen konnten einen zeitlich befristeten analgetischen Effekt nachweisen, die Hälfte beobachtete bei den Messkriterien Übelkeit, Erbrechen oder Kostaufbau jeweils einen positiven Effekt. Nur 15 Studien untersuchten jedoch sämtliche Messkriterien.

Schlussfolgerungen

Die vorliegenden Daten sprechen insgesamt dafür, dass Übelkeit, Erbrechen und Dauer des Kostaufbaus durch präoperative Steroidgabe signifikant zu reduzieren sind. Tendenziell gilt dies auch für den analgetischen Effekt. Zur abschließenden Bewertung sind jedoch noch weitere Studien notwendig. Hierbei muss auf die Elimination multipler Einflussfaktoren geachtet werden.

Abstract

Background

Of the morbidities that follow tonsillectomy, nausea and vomiting, fever, pain and inadequate oral intake are the most commonly encountered. The incidence of postoperative nausea and vomiting (PONV) has been reported as between 40% and 85%. In children, the risk of dehydration is increased owing to the delay in oral intake of fluids in the early postoperative period. In efforts to reduce postoperative morbidity, numerous modifications and adjuncts to the surgical procedure have been suggested, including the use of steroids.

Patients and methods

Reduction in PONV, pain and early return to a normal diet were studied as separate end-points in a review of the current literature.

Results

A total of 31 studies matched our search criteria and involved paediatric and adult patient populations. Only 15 studies evaluated pain, PONV and diet. The lack of standardised surgical and anaesthetic techniques and the variations in length of follow-up, concentration of steroids administered and patient age distribution weaken the impact of the results recorded in several studies. However, two-thirds show that a single intravenous dose of dexamethasone reduces pain, although this was limited to the early postoperative period. Moreover, 15 studies confirmed a beneficial effect of dexamethasone on both PONV and early oral intake.

Conclusions

Preoperative administration of a single dose of dexamethasone to reduce postoperative morbidity resulting from tonsillectomy is supported by several studies. Adverse events have never been reported. However, further studies are warranted to determine the optimum dose required and the effect in adult tonsillectomy patients. In addition, the data should be based on standardised surgical and anaesthetic techniques to allow reliable evaluation of the significance of all outcome measures.

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  1. Klinik für Hals-, Nasen-, Ohren-Krankheiten. Kopf-, Hals- und Plastische Gesichtschirurgie, Malteser Krankenhaus St. Anna, Albertus Magnus-Straße 33, 47259, Duisburg, Deutschland

    J. P. Windfuhr

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Windfuhr, J. Steroide zur Reduktion der Morbidität nach Tonsillektomie. HNO 56, 43–53 (2008). https://doi.org/10.1007/s00106-007-1550-8

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