Efficacy of dexamethasone for the prevention of nausea and vomiting associated with intrathecal chemotherapy and ketamine sedation in children with leukemia

Abstract

Objective: The purpose of this study was to determine whether vomiting and nausea associated with intravenous ketamine and intrathecal chemotherapy may be reduced by the addition of prophylactic dexamethasone in children. Design: A randomized, double-blinded, crossover, placebo-controlled trial Setting: Department of Pediatrics, Phramongkutklao Hospital Methods: The study was completed in thirty-three children receiving intrathecal chemotherapy with methotrexate 12mg and ketamine sedation at Pharmongkutklao Hospital. Patients were randomly assigned in a double-blinded fashion to receive one of two interventions at the first period, either an infusion of normal saline or intravenous dexamethasone at 0.25 mg/kg/dose. Each patient acted as his or her own control, and each patient was studied at least 2 times. Results: Period effect, sequence effect and carry over effect were not demonstrated. The absolute risk reduction of vomiting was significantly greater after infusion of dexamethasone than placebo at 33.3 % (p=0.02). Fifteen patients (45.5 %) in the treatment group nausea versus 26 patients (78.7 %) in the placebo group reported (p= 0.007). There was no any complication from dexamethasone. Conclusion: This study demonstrated that intravenous dexamethasone reduced vomiting induced by intrathecal chemotherapy and ketamine sedation, with no significance side-effects, and may be recommended a reasonable option before intrathecal chemotherapy.