"A Cochrane database review in 2011 examining children undergoing tonsillectomy concluded that children given a single dose of IV dexamethasone 0.15 to 1.0 mg.kg-1 (max 8-25mg) were half as likely to vomit in the first 24 hours after tonsillectomy
(Relative Risk = 0.49, 95% CI 0.41-0.58). Routine use of dexamethasone in children was associated with a NNT of 5. The authors do not provide a dose
recommendation due to the pitfalls of subgroups analysis within a meta-analysis.
A dose finding study of dexamethasone (0.25 to 1.0 mg.kg-1) in 168 children undergoing strabismus surgery compared to placebo identified no additional
benefit of using doses greater than 0.25 mg.kg-1. For all groups studied, there was an NNT of 2.2- 2.7. In all groups receiving dexamethasone there was no evidence of side effects relating to increased blood sugars or increased wound infection rates.
In another dose-finding study 215 children undergoing tonsillectomy were given dexamethasone (0.05 to 0.5 mg.kg-1) or placebo. The relative risk of POV (first 24hr) was reduced from 0.54 for 0.15 mg.kg-1 to 0.23 with 0.5 mg.kg-1 dexamethasone. Three studies have shown lower doses of dexamethasone provide similar clinically significant prevention of POV.
One study in 140 children used dexamethasone 150 mcg.kg-1 (max 8mg) and found an overall reduction in POV from 71% to 40%.
Another study compared low dose dexamethasone (50 mcg.kg-1 to 250 mcg.kg-1) finding a significant reduction in POV even with doses as small as 50 mcg.kg-1 The NNT range for all groups was 2-2.9."
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