Table 1.
Characteristics of included studies in meta-analysis
| Study (reference) | No of participants | Age inclusion criteria (years) | Procedure | Dissection technique | Drug regimen | NSAID use | Duration of follow-up | Bleeding outcome definition | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Steroids | Control | Steroids | Control | |||||||
| Catlin et al. (1991)32 | 10 | 15 | 4 to 12 | T, or T and A | Combined | Dexamethasone IV, 8 mg/m², before induction | Placebo | No | 3 weeks | NR |
| Volk et al. (1993)55 | 25 | 25 | 4 to 12 | T, or T and A | Combined | Dexamethasone IV, 10 mg, at induction | Placebo | No | 7 to 10 days | NR |
| Ohlms et al. (1995)47 | 34 | 35 | 3 to 18 | T, or T and A | Cold, combined | Dexamethasone IV, 0.5 mg/kg (max 12 mg), immediately before surgery | Placebo | No | 3 to 4 weeks | NR |
| April et al. (1996)30 | 41 | 39 | 3 to 15 | T and A | Hot | Dexamethasone IV, 1 mg/kg (max 16 mg), after induction | Placebo | NR | 24 h | NR |
| Tom et al. (1996)53 | 26 | 32 | 1 to 18 | T and A | Hot | Dexamethasone IV, 1 mg/kg (max 10 mg), after induction | Placebo | No | 10 days | NR |
| Kim et al. (1998)39 | 40 | 20 | 3 to 15 | T, or T and A | Combined | Dexamethasone IV, 1 mg/kg (max 15 mg), after induction or in the postanaesthetic care unit | No treatment or placebo | Yes | 3 days | NR |
| Carr et al. (1999)31 | 15 | 14 | Adults | T | Hot | Dexamethasone IV, 20 mg, during surgery | Placebo | No | 10 days | NR |
| Holt et al. (2000)36 | 68 | 60 | 2 to 14 | T, or T and A | Cold | Tropisetron and dexamethasone IV, 0.5 mg/kg (max 8 mg), after induction | Tropisetron alone, 0.1 mg/kg (max 2 mg) |
NR | 6 days | NR |
| Nawasreh et al. (2000)46 | 62 | 58 | 4 to 14 | T, or T and A | Hot | Dexamethasone IV, 1 mg/kg (max 16 mg), 1 h before surgery | Placebo | NR | 24 h | NR |
| Palme et al. (2000)48 | 25 | 25 | ≥5 | T, or T and A | Hot, combined | Prednisolone given orally, 10 mg daily (age 5-11 years) or 0.5 mg/kg daily (age ≥12 years), postoperative day 1 to 7 | Placebo | No | 2 weeks | NR |
| Giannoni et al. (2002)33 | 25 | 25 | 3 to 15 | T | Hot | Dexamethasone IV, 1 mg/kg (max 16 mg), after induction | Placebo | Yes | 10 days | NR |
| Güne et al. (2002)34 | 15 | 45 | 3 to 12 | T | NR | Dexamethasone IV, 0.15 mg/kg, after induction | 3 groups: placebo, ondansetron, 0.15 mg/kg, or droperidol, 0.075 mg/kg | NR | 6 h | NR |
| Stewart et al. (2002)52 | 132 | 68 | ≥16 | T | Hot | Dexamethasone alone or dexamethasone and piroxicam (same dose as controls); dexamethasone IV, 8 mg at induction, 2 mg on the night of surgery, 2 mg twice daily for 4 days, 2 mg daily for 4 days | Piroxicam alone, given orally: 10 mg given 2 h before surgery, 10 mg given on the night of surgery; 10 mg given twice daily for 4 days; 10 mg given daily for 4 days |
Yes | 2 weeks | NR |
| Hanasono et al. (2004)35 | 106 | 113 | ≤12 | T, or T and A | Hot, combined | Dexamethasone IV, 1 mg/kg (max 50 mg), at the start of surgery | Placebo | NR | 3 days | NR |
| Samarkandi et al. (2004)51 | 29 | 31 | 2 to 12 | T | Hot | Dexamethasone IV, 0.5 mg/kg, after induction | Placebo | NR | 24 h | NR |
| Malde et al. (2005)41 | 45 | 45 | >3 | T | Cold | Dexamethasone IV, 0.15 mg/kg, after induction | Placebo | NR | 7 days | NR |
| Trujillo et al. (2005)54 | 35 | 34 | 3 to 15 | T, or T and A | NR | Dexamethasone IV; 1 mg/kg (max 8 mg); immediately before surgery, 8 h after operation, 16 h after operation | Placebo | NR | 6 days | NR |
| Kaan et al. (2006)37 | 32 | 30 | 4 to 12 | T, or T and A | Cold | Dexamethasone IV, 0.5 mg/kg (max 16 mg), after induction | Placebo | NR | 8 h | NR |
| Kaufmann et al. (2006)38 | 101 | 103 | 2 to 16 | T and A | NR | Dexamethasone IV, 0.5 mg/kg (max 10 mg), during surgery | No treatment or placebo | NR | 10 days | NR |
| McKean et al. (2006)43 | 37 | 35 | 16 to 70 | T | Combined | Dexamethasone IV, 10 mg, at induction | Placebo | Yes | 7 days | NR |
| Mohammad et al. (2006)45 | 25 | 25 | 3 to 18 | T, or T and A | Cold, combined | Dexamethasone IV, 1 mg/kg (max 12 mg), during surgery | Unclear (placebo or no drug) |
Yes (steroid group 20%, controls 52%) | 24 h | NR |
| Alajmi et al. (2008)28 | 42 | 38 | 5 to 18 | T, or T and A | Cold, combined | Dexamethasone IV, 1 mg/kg (max 16 mg), after induction | Placebo | Yes (steroid group 14.3%, controls 47.4%) | 16 days | NR |
| Czarnetzki et al. (2008)12 | 161 | 54 | 2 to 17 | T, or T and A | Cold, hot, combined | 3 groups: dexamethasone IV, 0.05 mg/kg, 0.15 mg/kg, 0.5 mg/kg (max 20 mg); after induction | Placebo | Yes (steroid subgroups 38%, 43%, and 38%; controls 65%) | 10 days | History of bleeding leading to readmission, with or without evidence of bleeding at examination or need for emergency reoperation |
| Lachance et al. (2008)40 | 41 | 61 | 18 to 45 | T | Combined, 2 cold dissections in control group | Dexamethasone IV (8 mg during surgery), dexamethasone given orally (8 mg at home on day of surgery; 6, 4, and 2 mg twice daily on postoperative days 1, 2, and 3, respectively) | Placebo | No | 7 days | NR |
| Rujirojindakul et al. (2008)50 | 25 | 25 | 15 to 60 | T | Hot | Dexamethasone IV, 20 mg, after induction | Placebo | No | 7 days | NR |
| Ammar et al. (2009)29 | 30 | 30 | Adults and children | T, or T and A | Cold | Dexamethasone IV, 5 mg to children, 10 mg to adults, for 4 days after surgery | Placebo | Yes | 5 days | NR |
| Mohamed et al. (2009)44 | 100 | 50 | 2 to 12 | T, or T and A | Hot | 2 groups: dexamethasone alone or dexamethasone and glossopharyngeal nerve block (same dose as controls); dexamethasone IV, 0.15mg/kg (max 8 mg), before surgery | Bilateral glossopharyngeal nerve block alone with 3 mL of 0.5% bupivacaine | No | Until discharge time (up to 24 h) | NR |
| Rabbani et al. (2010)49 | 30 | 30 | Adults and children | T, or T and A | NR | Dexamethasone IV, 0.1 mg/kg for age <12 years or 8 mg for >12 years, at induction | Ondansetron, 0.1 mg/kg for age <12 years, 4 mg for age >12 years | NR | 24 h | NR |
| Mathiesen et al. (2011)42 | 48 | 99 | 18 to 50 | T | Combined | Dexamethasone IV, 8 mg, with paracetamol and pregabalin (same dose as controls) before induction | 2 groups: paracetamol alone, 1000 mg, or paracetamol and pregabalin, 300 mg | No | 2 weeks | Bleeding episodes requiring reoperation |
A=adenoidectomy; cold=dissection with cold steel instruments, haemostasis with gauze compression, or ligatures; combined=cold dissection with use of electrocautery for haemostasis; hot=dissection and haemostasis with electric device; IV=intravenous; max=maximum; NR=not reported; NSAID=non-steroidal anti-inflammatory drug; T=tonsillectomy.