Effects of Intraoperative Dexamethasone Administration in Adult Diabetic Burn Patients

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.

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

“…Two RCTs (Corcoran et al 2021a;Shang et al 2022) compared wound dehiscence, no patient developed wound dehiscence in the two RCTs, so there were no statistical differences between groups. Only one cohort study (Egan et al 2019) investigated wound dehiscence, the follow-up time was 90 days, and showed no between-group differences (P < 0.05).…”

“…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.…”

“…Ten (Nazar et al 2011;Tien et al 2016;Nazar et al 2009;Corcoran et al 2021a;Purushothaman et al 2018;Zhang et al 2014;Shang et al 2022;Wasfie et al 2018;Egan et al 2019;Corcoran et al 2021b), six (Tien et al 2016;Corcoran et al 2021a;Purushothaman et al 2018;Zhang et al 2014;Shang et al 2022;Wasfie et al 2018), nine (Nazar et al 2011;Tien et al 2016;Corcoran et al 2021a;Purushothaman et al 2018;Zhang et al 2014;Shang et al 2022;Wasfie et al 2018;Allen et al 2020;O'Connell et al 2018), six (Tien et al 2016;Corcoran et al 2021a;Shang et al 2022;Egan et al 2019;Harding et al 2021;O'Connell et al 2018) and two (Egan et al 2019;O'Connell et al 2018) studies reported glucose levels at baseline (preoperatively), intraoperatively (in the midterm of surgery), at the end of surgery, on postoperative day 1 (POD 1), and POD 2. The results in the trial by Corcoran TB 2020(Corcoran et al 2021a were split in the forest plot, with Corcoran TB 2020(1) representing the comparison between dexamethasone 4 mg with control, and Corcoran TB 2020(2) representing the comparison between dexamethasone 8 mg with control.…”

“…Two RCTs (Corcoran et al 2021a;Corcoran et al 2021b) and 2 cohort studies (Egan et al 2019;Harding et al 2021) representing the comparison between dexamethasone 4 mg with control, and Corcoran TB2020(2) representing the comparison between dexamethasone 8 mg with control. The result from meta-analysis with fixed model method revealed that there was no between-group difference in wound infection (OR: 0.797, 95%CI: 0.578-1.099, I 2 = 0%, P = 0.166) (Fig.…”

“…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) were published from 2009 to 2022, 9 were RCTs(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;Corcoran et al 2021b), and the other 7(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) were cohort studies, all studies reported dexamethasone for antiemesis, and the dosage of dexamethasone ranged from 4 to 12 mg daily during the perioperative period. In the 9 RCTs, dexamethasone was administered at induction of anesthesia or before anesthesia, 8 studies(Nazar et al 2011;Tien et al 2016;Nazar et al 2009;Corcoran et al 2021a;Purushothaman et al 2018;Zhang et al 2014; Shang et al 2022;Corcoran et al 2021b) compared dexamethasone with saline, and 1(Backes et al 2013) compared dexamethasone with no treatment.…”