Original ContributionPostoperative hyperglycemia after 4- vs 8-10-mg dexamethasone for postoperative nausea and vomiting prophylaxis in patients with type II diabetes mellitus: a retrospective database analysis☆
Introduction
The corticosteroid dexamethasone provides effective prophylaxis for postoperative nausea and vomiting (PONV) [1]. The 2014 Society for Ambulatory Anesthesia guidelines recommend a 4-5-mg dose of dexamethasone at induction of anesthesia [2]. A recent meta-analysis of 60 randomized controlled trials found no difference in antiemetic efficacy between 4 and 5 mg and 8-10-mg doses of dexamethasone [3]. However, another meta-analysis suggested that the higher dose might be associated with improved opioid sparing and pain scores compared with lower doses [4].
Several studies [5], [6], [7], [8], [9], [10] and a recent meta-analysis [11] reported increased postoperative blood glucose in patients receiving PONV prophylaxis with dexamethasone. This effect was seen in both diabetic and nondiabetic patients, leading some authors to caution against the use of dexamethasone in patients with diabetes mellitus [12]. Although tight perioperative glucose control does not improve outcomes and carries an increased risk of hypoglycemia [13], some authors have noted that severe hyperglycemia may be associated with an increase in surgical wound infections and impaired wound healing and appears to have a negative impact on morbidity and mortality particularly after cardiac and neurologic surgeries [14], [15], [16]. Most previous studies investigating the impact of dexamethasone on postoperative blood glucose levels used doses of 8-10 mg. Although most studies reported an increase in blood glucose with dexamethasone administration, a recent randomized prospective study involving 200 nondiabetic patients undergoing gynecologic surgery reported no significant difference in postoperative blood glucose concentrations after the administration of placebo, 4 or 8 mg dexamethasone [17]. No similar studies were conducted in diabetic patients, and, therefore, it remains unclear whether the dose of dexamethasone used for PONV prophylaxis has an effect on the degree of postoperative hyperglycemia in diabetic patients.
We therefore carried out this retrospective study of patients with type II diabetes mellitus to assess whether postoperative hyperglycemia after single-dose dexamethasone for PONV prophylaxis is dose related.
Section snippets
Materials and methods
After institutional review board approval, we searched the perioperative database for patients aged > 18 years, American Society of Anesthesiologists (ASA) physical status I-IV, with diagnosed type II diabetes mellitus based on International Classification of Diseases, Ninth Revision diagnosis code, undergoing elective surgery between January 1, 2006, and March 31, 2012, at our institution who received 4 or 8-10 mg dexamethasone for PONV prophylaxis, and were hospitalized for at least 24 hours
Results
Our initial search of the database yielded 3157 diabetic patients who received preoperative or intraoperative dexamethasone. Of these, 2005 were type II diabetic patients. We excluded patients who were found to have conflicting data points on cross-check of the database values and anesthesia records (n = 10), emergency cases (n = 205), patients who had received preoperative or intraoperative dextrose 50 % (n = 158) or preoperative insulin (n = 114) in the preoperative holding area, those who
Discussion
Our results show that the use of 8-10 mg of dexamethasone in patients with type II diabetes mellitus is associated with significantly greater increase in postoperative blood glucose compared with the 4-mg dose in PACU (by 9 mg/dL) and over the first 24 postoperative hours (by 25 mg/dL). The clinical significance of this is unclear and may be limited, although the higher dose was also associated with significantly more insulin requirements in PACU.
Other than dexamethasone dose, higher
References (21)
- et al.
Blood glucose concentration profile after 10 mg dexamethasone in non-diabetic and type 2 diabetic patients undergoing abdominal surgery
Br J Anaesth
(2006) - et al.
Effect of dexamethasone on oral glucose tolerance in healthy adults
Endocr Pract
(2010) - et al.
Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis
Br J Anaesth
(2013) - et al.
Dexamethasone prevents postoperative nausea and vomiting: benefit versus risk
Acta Anaesthesiol Taiwan
(2011) - et al.
Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial
Br J Anaesth
(2013) - et al.
A study of perioperative hyperglycemia in patients with diabetes having colon, spine, and joint surgery
J Perianesth Nurs
(2009) - et al.
Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review
Anesth Analg
(2000) - et al.
Consensus guidelines for the management of postoperative nausea and vomiting
Anesth Analg
(2014) - et al.
Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials
Anesth Analg
(2013) - et al.
Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials
Anesthesiology
(2011)
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2021, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Furthermore, many studies that have examined the effect of short courses of glucocorticoids on postoperative infection, morbidity, and wound healing have failed to show a negative effect in the areas of orthopedic surgery, esthetic surgery, gynecologic surgery, tonsillar surgery, and facial fractures, among others.38-47 Even in diabetic patients, glucocorticoids have been used for elective surgery without apparent complications48-52; however, some authors noted a transient elevation of blood glucose level with dexamethasone.49,50 The data presented in our article suggest that dexamethasone may have a role as adjunctive treatment in odontogenic infections, but further data are needed to support or refute this finding.
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This study was supported solely by departmental funds.