{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T03:54:54Z","timestamp":1784865294567,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100016193","name":"University of Colorado School of Medicine, Anschutz Medical Campus","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016193","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Tonsillectomy is associated with a high rate of postoperative nausea and vomiting (PONV), ranging between 40% and 73%, and dexamethasone has been found to have a prophylactic effect on PONV in children undergoing tonsillectomy. In 2020, there was a sudden, severe shortage of intravenous dexamethasone given its role in treating patients with COVID\u201019. The primary aim of this study was to investigate the viability of an alternative: non\u2010inferiority of oral versus intravenous dexamethasone for preventing PONV. Secondary objectives included pain and surgical complication outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>One hundred twenty\u2010six patients aged 3 to 7\u2009years old undergoing tonsillectomy were prospectively randomized to receive 0.5\u2009mg\/kg oral or intravenous dexamethasone (maximum dose 8\u2009mg). PONV data were recorded from the post\u2010anesthesia care unit and post\u2010op day 3 to 5 nursing phone calls. Pain was assessed using the numeric pain scale 0 to 10 or the Faces, Legs, Arms, Crying, Consolability (FLACC) Scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010two (57.1%) males and 54 (42.9%) females with a mean age of 5.36\u2009years were included in the analysis. Sixty\u2010three (50.0%) patients received oral dexamethasone, and 63 patients received intravenous dexamethasone. Three patients were noted to have nausea in the post\u2010anesthesia care unit, all of whom received oral dexamethasone (2.4%), an absolute risk difference of 4.8% (95% CI 1.6% to 9.5%). Four patients had vomiting in the post\u2010anesthesia care unit, all of whom received oral dexamethasone (3.2%), an absolute risk difference of 6.3% (95% CI 1.6% to 11.1%). Fifteen patients reported nausea and vomiting after discharge; 6\/15 (40%) received oral dexamethasone and 9\/15 (60%) received intravenous dexamethasone (absolute risk difference \u22125.4% (95% CI \u221215.6% to 4.9%)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Substituting oral dexamethasone in place of intravenous dexamethasone resulted in a non\u2010inferior rate of PONV for pediatric patients undergoing tonsillectomy. Oral dexamethasone is a reasonable substitute for intravenous dexamethasone, particularly during an immediate, unexpected medication shortage.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.70046","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T12:26:12Z","timestamp":1757334372000},"page":"953-961","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Seeking a Viable Alternative: A Prospective, Randomized, Controlled, Double\u2010Blind Non\u2010Inferiority Study of Oral Versus <scp>IV<\/scp> Dexamethasone in Children Undergoing Tonsillectomy"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9226-1096","authenticated-orcid":false,"given":"Melissa","family":"Brooks Peterson","sequence":"first","affiliation":[{"name":"Independent 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