[en] BACKGROUND: Dexamethasone prevents postoperative nausea and vomiting but may increase blood glucose. We compared blood glucose concentrations after dexamethasone in non-diabetic and type 2 diabetic patients undergoing surgery and looked for any association with preoperative glycosylated haemoglobin [HbA (1c)] and BMI. METHODS: Sixty three patients were enrolled: 32 were non-diabetic (Group ND) and 31 type 2 diabetic (Group D) without insulin treatment. Anaesthesia was induced using i.v. anaesthetic agents and maintained with sevoflurane. All patients received 10 mg dexamethasone at induction. Blood glucose concentrations were measured at induction and then every 60 min for 240 min. Data were analysed using anova. Effects of HbA (1c) and BMI were investigated using linear correlation and logistic regression. RESULTS: Blood glucose concentrations increased significantly over time and peaked at 120 min after 10 mg dexamethasone in both groups. The magnitude of increase was comparable between the groups [mean (SD) 29 (19) and 35 (19)% of baseline in Group D and Group ND, respectively]. Maximum concentrations were higher in Group D [8.97 (1.51) mmol litre(-1), range 6.67-12.94 mmol litre(-1)] than in Group ND [7.86 (1.00) mmol litre(-1), range 5.78-10.00 mmol litre(-1)]. There was a significant correlation between the maximum concentrations and BMI (R(2)=0.21) or HbA (1c) (R(2)=0.26). Logistic regression analysis revealed that the higher the BMI, the lower the HbA (1c) threshold associated with an increased probability (>0.5) of observing blood glucose levels higher than 8.33 mmol litre(-1) during 240 min after dexamethasone administration. Similarly, the higher the HbA (1c), the lower the BMI threshold associated with the same probability. CONCLUSIONS: After 10 mg dexamethasone, blood glucose levels increase in non-diabetic and type 2 diabetic patients undergoing abdominal surgery. Poorly controlled diabetes and severe obesity can influence the development of hyperglycaemia.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Hans, Pol ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Vanthuyne, A.
DEWANDRE, Pierre-Yves ; Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
Brichant, Jean-François ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Bonhomme, Vincent ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Language :
English
Title :
Blood glucose concentration profile after 10 mg dexamethasone in non-diabetic and type 2 diabetic patients undergoing abdominal surgery
Panda NB, Bharadwaj N, Kapoor P, Chari P, Panda NK. Prevention of nausea and vomiting after middle ear surgery: Combination of ondansetron and dexamethasone is the right choice. J Otolaryngol 2004; 33: 88-92
Fujii Y, Numazaki M. Randomized, double-blind comparison of subhypnotic-dose propofol alone and combined with dexamethasone for emesis in parturients undergoing cesarean delivery. Clin Ther 2004; 26: 1286-91
Madan R, Bhatia A, Chakithandy S, et al. Prophylactic dexamethasone for postoperative nausea and vomiting in pediatric strabismus surgery: A dose ranging and safety evaluation study. Anesth Analg 2005; 100: 1622-6
Lee Y, Lai HY, Lin PC, Lin YS, Huang SJ, Shyr MH. A dose ranging study of dexamethasone for preventing patient-controlled analgesia-related nausea and vomiting: A comparison of droperidol with saline. Anesth Analg 2004; 98: 1066-71
Kaal EC, Vecht CJ. The management of brain edema in brain tumors. Curr Opin Oncol 2004; 16: 593-600
Lundin A, Magnuson A, Axelsson K, Nilsson O, Samuelsson L. Corticosteroids perioperatively diminishes damage to the C-fibers in microscopic lumbar disc surgery. Spine 2005; 30: 2362-7
Jamieson NB, Glen P, McMillan DC, et al. Systemic inflammatory response predicts outcome in patients undergoing resection for ductal adenocarcinoma head of pancreas. Br J Cancer 2005; 92: 21-3
Singh M, Mohta M, Sethi AK, Tyagi A. Efficacy of dexamethasone pretreatment for alleviation of propofol injection pain. Eur J Anaesthesiol 2005; 22: 888-90
Pasternak JJ, McGregor DG, Lanier WL. Effect of single-dose dexamethasone on blood glucose concentration in patients undergoing craniotomy. J Neurosurg Anesthesiol 2004; 16: 122-5
Matsumoto K, Yamasaki H, Akazawa S, et al. High-dose but not low-dose dexamethasone impairs glucose tolerance by inducing compensatory failure of pancreatic beta-cells in normal men. J Clin Endocrinol Metab 1996; 81: 2621-6
Rhee MS, Perianayagam A, Chen P, Youn JH, McDonough AA. Dexamethasone treatment causes resistance to insulin-stimulated cellular potassium uptake in the rat. Am J Cell Physiol 2004; 287: C1229-37
Juvela S, Siironen J, Kuhmonen J. Hyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage. J Neurosurg 2005; 102: 998-1003
Doenst T, Wijeysundera D, Karkouti K, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thoracic Cardiovasc Surg 2005; 130: 1144
Ouattara A, Lecomte P, Le Manach Y, et al. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology 2005; 103: 687-94
Lukins MB, Manninen PH. Hyperglycemia in patients administered dexamethasone for craniotomy. Anesth Analg 2005; 100: 1129-33
Faul F, Erdfelder E. GPOWER: A priori, post-hoc, and compromise power analyses for MS-DOS [Computer program]. Bonn, FRG: Bonn University, Department of Psychology, 1992. Available from http://www.psychologie.uni-trier.de:8000/projects/gpower
Garg R, Chaudhuri A, Munschauer F, Dandona P. Hyperglycemia, insulin, and acute ischemic stroke: A mechanistic justification for a trial of insulin infusion therapy. Stroke 2006; 37: 267-73
Lees KR, Walters MR. Acute stroke and diabetes. Cerebrovasc Dis 2005; 20 (Suppl. 1): 9-14
Morariu AM, Loef BG, Aarts LP, et al. Dexamethasone: Benefit, prejudice for patients undergoing on-pump coronary artery bypass grafting: A study on myocardial, pulmonary, renal, intestinal, and hepatic injury. Chest 2005; 128: 2677-87
Lattermann R, Schricker T, Georgieff M, Schreiber M. Low dose clonidine premedication accentuates the hyperglycemic response to surgery. Can J Anaesth 2001; 48: 755-9
