Peter Vigil, Shenoy Usha, Rukkiyabeevi Buena
Department of Anaesthesia, Jubilee Mission Medical College and Regional Institute, Thrissur, Kerala, India.
Indian J Anaesth. 2022 Nov;66(11):789-795. doi: 10.4103/ija.ija_332_22. Epub 2022 Nov 18.
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.
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.
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.
Even a single dose of dexamethasone in non-diabetic adults causes significant and prolonged postoperative hyperglycaemia.
术中单次给予类固醇激素对围手术期血糖水平的影响尚不确定。我们假设单次给予地塞米松不会对非糖尿病患者的血糖水平产生不利影响。本研究旨在评估非糖尿病患者术中单次给予地塞米松后的术后血糖情况。同时还评估了术后恶心呕吐（PONV）、疼痛、手术部位感染（SSI）及住院时间。
本随机、双盲、对照研究招募了150例接受择期手术的美国麻醉医师协会身体状况I/II级的非糖尿病成年患者。研究组患者给予单次剂量的地塞米松（0.15mg/kg）。术后使用即时检测在长达72小时的不同时间点评估血糖水平。还记录了PONV、疼痛、发热和SSI等次要结局。使用学生t检验、卡方检验、曼-惠特尼检验和方差分析对数据进行比较和分析。
接受地塞米松的患者血糖水平出现更早、更高且持续时间更长的升高。研究组术后第1天、第2天和第3天空腹/餐后血糖的平均值（标准差）分别为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，显著高于对照组86.96（10.28）/128.95（10.53）、88.81（8.87）/131.97（9.68）、88.16（8.50）/130.88（9.48）mg/dl。约10.7%接受地塞米松的患者血糖水平高于180mg/dl。次要结局方面无显著差异。
即使在非糖尿病成年人中单次给予地塞米松也会导致显著且持续时间较长的术后高血糖。
