A prospective randomized study on the impact of low-dose dexamethasone on perioperative blood glucose concentrations in diabetics and nondiabetics

Abstract

Background:Dexamethasone is a potent corticosteroid when administered alone or in combination alone has proven efficacious in preventing nausea and vomiting (PONV) perioperatively. However, the administration of even a single dose has been associated with hyperglycemia. This is the first study that evaluates the effect of two low-doses of dexamethasone (4 and 8 mg) on blood glucose concentrations among diabetics and nondiabetics in patients who have received spinal anesthesia.Materials and Methods:After obtaining ethical clearance and patient consent, 180 American Society of Anesthesiologists 1–3 patients undergoing the elective infraumbilical surgeries under spinal anesthesia aged between 18 and 70 years were included in this study. Ninety diabetic patients were allotted to the diabetic group (DM), and ninety nondiabetic patients were allotted to the nondiabetic group (ND). Group DM was divided into three subgroups DM0, DM4, and DM8. Group ND was divided into three subgroups ND0, ND4, and ND8. The patients in groups DM0 and ND0 served as controls. The patients in groups DM4 and ND4 received 4 mg dexamethasone. The patients in groups DM8 and ND8 received 8 mg dexamethasone. The blood glucose concentrations were monitored at 0 (baseline), 1, 2, 3, 4, 5, 6, and 8 h after giving the drug.Results:The baseline blood glucose values were higher in diabetics compared to nondiabetics (128.57 ± 22.26 vs 94.99 ± 12.82 mg/dL). There was a statistically significant increase in blood glucose concentrations in both diabetics and nondiabetics who received dexamethasone. The rise of blood glucose from baseline was similar in both diabetics and nondiabetics.Conclusion:The maximum rise in blood glucose was in the range of 40–45 mg/dl in the patients who received dexamethasone. The clinician should use his clinical judgment before administering dexamethasone for PONV prophylaxis/treatment.

Attitudes towards the use of perioperative steroids in resectional colorectal cancer surgery in the UK: A qualitative study

“…Based on this survey there is concern regarding the use of perioperative single dose dexamethasone within the diabetic cohort of patients, particularly those with insulin dependent diabetes. Two recent randomised control trials [14,15] have reported a significant increase in blood glucose levels following dexamethasone administration in both diabetic and non-diabetic patients although there was no significant difference in the size of the effect between diabetics/non-diabetics in either study. A recent Cochrane review [16].…”

The safety of perioperative dexamethasone with antiemetic dosage in surgical patients with diabetes mellitus: a systematic review and meta-analysis

“…The full versions of 41 articles were retrieved after screening and conducting a detailed selection process. Finally 16 articles (Nazar et al 2011;Tien et al 2016;Nazar et al 2009;Corcoran et al 2021a;Backes et al 2013;Purushothaman et al 2018;Zhang et al 2014;Shang et al 2022;Wasfie et al 2018;Herbst et al 2020;Godshaw et al 2019;Allen et al 2020;Egan et al 2019;Harding et al 2021;O'Connell et al 2018;Corcoran et al 2021b) met the inclusion criteria and underwent data extraction. The details of the screening procedure are shown in Fig.…”

“…The 16 included studies (Nazar et al 2011;Tien et al 2016;Nazar et al 2009;Corcoran et al 2021a;Backes et al 2013;Purushothaman et al 2018;Zhang et al 2014;Shang et al 2022;Wasfie et al 2018;Herbst et al 2020;…”

Comparison of Dexamethasone 4mg vs 8mg Doses in Total Joint Arthroplasty Patients: A Retrospective Analysis

“…Administration of dexamethasone raises blood glucose levels posing unique challenges in patients with diabetes. For diabetic patients, there is conflicting evidence regarding whether or not there is a dose dependent response in the elevation of blood glucose levels [16][17][18]. The anti-inflammatory nature of corticosteroids, through inhibition of prostaglandin synthesis, may also have detrimental side effects with high or repeated dosing.…”