The effect of dexamethasone on the incidence of post extubation stridor in pediatric patients

Post extubation stridor is due to reactive subglottic laryngeal edema at the cricoid ring. Dexamethasone has been used to reduce the incidence of stridor in such patients. The evidence in the literature however is not conclusive. We conducted a prospective, randomized, double blind study of dexamethasone versus placebo to assess the efficacy of dexamethasone in reducing the incidence of post extubation stridor in children. Fifty-one patients without any known preexisting upper airway problems were studied. There were 27 patients in the treatment group and 24 in the placebo group. Both groups had similar weight, age and length of intubation. Dexamethasone was given at a dose of 0.6 mg/kg at 12 h and 1 h prior to extubation for a total of 2 doses. The control group received placebo at corresponding times.

There was no statistical difference in the incidence of post extubation stridor in the two groups. Ten of 24 children in the placebo group (41.7%) and 8 of 27 (30%) in the dexamethasone group developed stridor (P = 0.39). There were 3 patients in placebo group and 1 in dexamethasone group that needed reintubation, but again the difference was not statistically significant (P = 0.33).

This study, although with relatively small sample size, suggests that routine use of dexamethasone to prevent post extubation stridor, in children without any known upper airway abnormality, is not warranted.