No abstract

The steroid dexamethasone is used intraoperatively to prevent postoperative nausea. Studies of intraoperative steroid use in diabetic patients have shown conflicting effects on blood glucose and complications, and their use has not yet been studied in the burn population. A review of adult diabetic acute burn patients undergoing surgery at a verified burn center from 2012 to 2017 was conducted. Statistical analysis compared those who did and did not receive an intraoperative steroid. A total of 74 patients who underwent 121 operations were identified; steroid was administered in 14.0% of cases. There were no statistically significant differences in preoperative glucose, insulin requirements, TBSA, or hemoglobin A1C. Postoperatively, the steroid group had a 16.7 mg/dl (SD = 11.1) increase in blood glucose (P = .042) and 53.5 unit/24 hour (SD = 28.4) increase in insulin requirement (P = .019), compared with no change in controls. The complication rate in the steroid group was 52.9% compared with 20.1% in controls (P = .003); partial graft loss was the most common complication. Diabetic burn patients who receive intraoperative steroid have increased postoperative blood glucose levels, insulin requirements, and complication rates compared with patients who do not receive steroids. Discussion is warranted to avoid intraoperative steroid in this population.

Receiving a breast cancer diagnosis is a life-changing experience, and the need to undergo a mastectomy can generate many emotions. Hopelessness, ambivalence, body image disturbance, depression, and anxiety can result. 1,2 Preoperative psychological state and comorbidities may affect postoperative pain control and opioid use. Preoperative psychiatric comorbidities have been linked to increased acute postoperative pain following breast cancer surgery. 3,4 A history of depression or anxiety has also been shown to predict higher opioid consumption postoperatively. 5 Furthermore, these comorbidities can lead to long-term postoperative consequences of chronic surgical site pain and persistent opioid use. 6,7 In addition to psychiatric comorbidities, preoperative pain levels have also been found to predict more severe postoperative pain in breast cancer patients. 4,8 The severity of pain can also be predicted by coping