The Effects of Perioperative Dexamethasone on Glycemic Control and Postoperative Outcomes

Herbst, Rebecca; Telford, Onala; Hunting, John; Bullock, W. Michael; Manning, Erin; Hong, Beatrice; D’Alessio, David A.; Setji, Tracy L.

doi:10.4158/ep-2019-0252

Cited by 22 publications

(43 citation statements)

References 38 publications

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“…We found that intraoperative steroid use in non-diabetic patients increased the incidence of hyperglycemia, which is consistent with results from other studies [ 19 , 20 ]. However, this finding was different from the previous study by Corcoran et al, which described that 4 or 8 mg of dexamethasone did not cause intraoperative hyperglycemia [ 21 ].…”

Section: Discussionsupporting

confidence: 93%

Incidence and risk factors of intraoperative hyperglycemia in non-diabetic patients: a prospective observational study

et al. 2022

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Background Intraoperative hyperglycemia has been associated with multiple postoperative complications such as surgical site infection, myocardial infarction, stroke, and death. These complications are not confined to only diabetic patients. However, the incidence of intraoperative hyperglycemia in non-diabetic patients has not been fully elucidated. Additionally, these patients’ risk factors were not well established in previous studies. Methods Four hundred forty non-diabetic patients who underwent intermediate- to high-risk surgery were included in the study. We prospectively measured the capillary blood glucose level in all patients during surgery. The incidence of intraoperative hyperglycemia was defined as at least one episode of blood glucose level of more than 180 mg/dL. Risk factors for hyperglycemia were assessed using multivariable logistic regression analysis. Results Sixty-five (14.7%) patients developed hyperglycemia during surgery. The independent risk factors for intraoperative hyperglycemia were an American Society of Anesthesiologists status ≥ 3 (odds ratio [OR] 6.09, 95% confidence interval [CI]: 2.67–13.89, p < 0.001), preoperative impaired fasting blood sugar (OR 2.28, 95%CI:1.13–4.61, p = 0.021), duration of anesthesia ≥ 3 h (OR 4.06, 95%CI: 1.23–13.45, p = 0.021), intraoperative hypotension (OR 5.37, 95%CI: 2.35–12.29, p < 0.001), intraoperative blood transfusion (OR 4.35, 95%CI: 2.15–8.79, p < 0.001), and steroid use (OR 2.39, 95%CI: 1.20–4.76, p = 0.013). Surgical site infection was higher in patients with intraoperative hyperglycemia compared with patients without intraoperative hyperglycemia (4 [6.1%] vs. 6 [1.6%], respectively, p = 0.035). Conclusion The incidence of intraoperative hyperglycemia was significant in non-diabetic patients during intermediate- to high-risk surgery. Risk factors should be identified to prevent intraoperative hyperglycemia. Trial registration The study was prospectively registered at https://www.thaiclinicaltrials.org (TCTR20191114001).

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Section: Discussionsupporting

confidence: 93%

Incidence and risk factors of intraoperative hyperglycemia in non-diabetic patients: a prospective observational study

et al. 2022

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“…showed that perioperative steroids were associated with a 20% decrease in the LOS which may be due to reduced postoperative pain and nausea and subsequent reduced opioid requirements. [ 4 ]…”

Section: Discussionmentioning

confidence: 99%

“…found that the administration of a single dose of dexamethasone, raised blood sugar levels transiently, without any adverse patient outcomes. [ 4 ] Existing data on the changes in glycaemic profile is restricted to the intraoperative and the first 24 hours of the post-operative period. Considering the longer biological half-life of dexamethasone (36 to 54 hours), there is a paucity of prospective studies on the prolonged impact of a single dose of dexamethasone on the perioperative blood glucose levels for the entire period.…”

Section: Introductionmentioning

confidence: 99%

Effect of a single intraoperative dose of dexamethasone on glycaemic profile in postoperative patients - A double-blind randomised controlled study

Peter

Shenoy

Rukkiyabeevi

2022

Indian Journal of Anaesthesia

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Background and Aims: The effect of a single intraoperative dose of steroids on perioperative blood sugar levels is uncertain. We hypothesised that a single dose of dexamethasone would not unfavourably alter the glucose levels of non-diabetic patients. This study aimed to evaluate the post-operative glycaemic profile after a single dose of intraoperative dexamethasone in non-diabetic patients. The presence of post-operative nausea and vomiting (PONV), pain, surgical site infection (SSI) and length of hospital stay were also evaluated. Methods: This randomised, double-blind, controlled study was done by recruiting 150 non-diabetic adult patients of the American Society of Anesthesiologists physical status I/II undergoing elective surgery. Patients in the study group were administered a single dose of dexamethasone (0.15 mg/kg). Blood glucose levels were assessed at various time points for up to 72 hours post-operatively using point-of-care testing. Secondary outcomes such as PONV, pain, fever and SSI were also documented. Data were compared and analysed using Student’s t-test, Chi-square test, Mann-Whitney test and analysis of variance test. Results: There was an earlier, higher and prolonged elevation in blood glucose levels in patients receiving dexamethasone. The mean (standard deviation) of fasting/postprandial blood sugars on the first, second and third postoperative days respectively was significantly higher in the study group 98.04 (21.89)/139.16 (20.59), 96.64 (19.20)/138.17 (18.05), 96.60 (17.40)/138.32 (15.10) mg/dl as compared to control group 86.9 6 (10.28)/128.95 (10.53), 88.81 (8.87)/131.97 (9.68), 88.16 (8.50)/130.88 (9.48) mg/dl. About 10.7% of the patients who received dexamethasone had blood glucose levels greater than 180 mg/dl. There were no significant differences in the secondary outcomes. Conclusion: Even a single dose of dexamethasone in non-diabetic adults causes significant and prolonged postoperative hyperglycaemia.

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“…Although the findings of the RECOVERY study [ 4 ] and a recent meta-analysis [ 14 ] support the indication of dexamethasone in patients with COVID-19 (requiring ventilation or oxygen requirement to reduce mortality); corticosteroid therapy with dexamethasone increases hyperglycemia [ 15 ]. Our findings suggest the personalized risk/benefit assessment of this drug in patients with diabetes and COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Daily glucose variation influenced by the use of corticosteroids in COVID-19 patients treated in Lima-Peru

Cardoza-Jiménez

Carranza-Zavala

Franco

et al. 2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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Aim The pandemic has generated the need for COVID-19 patients to be treated as best as possible; however, the effect of these treatments on glycemic control has not yet been taken into account. This article aims to determine whether the daily variation of glucose is influenced by the use of corticosteroids in COVID-19 patients treated in Lima-Peru. Methodology A prospective cohort study was undertook, in which glucose was measured four times a day in 53 patients hospitalized due to COVID-19. These values were associated with the use of corticosteroids and adjusted for other socio-educational variables, all by means of PA-GEE models. Results Nested multivariate analysis of daily glucose variation found that those using corticosteroids increased the daily average glucose as well as the first and last glucose measurements, this is, at 6am and 10pm, respectively (all p-values <0.026). An increase in glucose levels was also observed in those with diabetes (all p-values <0.001). In contrast, we found that there was a decrease in the last glucose measurement of the day in obese patients (p-value = 0.044). Conclusions The patients who used corticosteroids for the treatment of COVID-19 increased the average glucose per day, especially in the first and last measurement.

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The Effects of Perioperative Dexamethasone on Glycemic Control and Postoperative Outcomes

Cited by 22 publications

References 38 publications

Incidence and risk factors of intraoperative hyperglycemia in non-diabetic patients: a prospective observational study

Incidence and risk factors of intraoperative hyperglycemia in non-diabetic patients: a prospective observational study

Effect of a single intraoperative dose of dexamethasone on glycaemic profile in postoperative patients - A double-blind randomised controlled study

Daily glucose variation influenced by the use of corticosteroids in COVID-19 patients treated in Lima-Peru

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