From the Department of Anesthesiology, Centro Hospitalar de Setúbal E.P.E., Setúbal, Portugal.
Department of Anesthesiology, Centro Hospitalar de Lisboa Ocidental E.P.E., Lisboa, Portugal.
Anesth Analg. 2024 Sep 1;139(3):490-508. doi: 10.1213/ANE.0000000000006933. Epub 2024 Aug 16.
Dexamethasone is associated with increased blood glucose levels that could impact patient outcomes or management. This study aimed to synthesize the available evidence regarding the impact of an intraoperative single dose of dexamethasone on blood glucose levels.
We searched CENTRAL, MEDLINE, and clinicaltrials.gov for randomized controlled trials (RCTs) comparing a single intraoperative dose of dexamethasone to control in adult patients who underwent noncardiac surgery. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the review was registered in PROSPERO (CRD42023420562). Data were pooled using a random-effects model. We reported pooled dichotomous data using odds ratios (OR) and continuous data using the mean difference (MD), reporting 95% confidence intervals (95% CIs), and corresponding P-values for both. Confidence in the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. As primary outcomes we assessed maximum blood glucose levels measurement and variation from baseline within 24 hours of surgery; blood glucose levels measurement and variation from baseline at 2, 4, 8, 12, and 24 hours after dexamethasone administration. As secondary outcomes, we evaluated insulin requirements and hyperglycemic events.
We included 23 RCTs, enrolling 11,154 participants overall. Dexamethasone was associated with a significant increment in blood glucose levels compared to control at all timepoints. The results showed an increase compared to control of 0.37 mmol L-1 (6.7 mg dL-1) at 2 hours (95% CI, 0.16-0.58 mmol L-1 or 2.9-10.5 mg dL-1), 0.97 mmol L-1 (17.5 mg dL-1) at 4 hours (95% CI, 0.67-1.25 mmol L-1 or 12.1-22.5 mg dL-1), 0.96 mmol L-1 (17.3 mg dL-1) at 8 hours (95% CI, 0.55-1.36 mmol L-1 or 9.9-24.5 mg dL-1), 0.90 mmol L-1 (16.2 mg dL-1) at 12 hours (95% CI, 0.62-1.19 mmol L-1 or 11.2-21.4 mg dL-1) and 0.59 mmol L-1 (10.6 mg dL-1) at 24 hours (95% CI, 0.22-0.96 mmol L-1 or 4.0-17.3 mg dL-1). No difference was found between subgroups regarding diabetic status (patients with diabetes versus patients without diabetes) in all the outcomes except 2 (maximum blood glucose levels variation within 24 hours and variation at 4 hours) and dexamethasone dose (4-5 mg vs 8-10 mg) in all the outcomes except 2 (blood glucose levels at 24 hours and hyperglycemic events).
Mean blood glucose levels rise between 0.37 and 1.63 mmol L-1 (6.7 and 29.4 mg dL-1) within 24 hours after a single dose of dexamethasone administered at induction of anesthesia compared to control, but in most patients this difference will not be clinically relevant.
地塞米松会导致血糖升高，这可能会影响患者的预后或治疗。本研究旨在综合现有证据，评估麻醉诱导时单次使用地塞米松对血糖水平的影响。
我们在 CENTRAL、MEDLINE 和 clinicaltrials.gov 中检索了比较非心脏手术成人患者接受单次术中地塞米松与对照组的随机对照试验（RCT）。我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南，并在 PROSPERO（CRD42023420562）中进行了注册。使用随机效应模型汇总数据。我们使用比值比（OR）报告汇总的二分类数据，使用均值差（MD）报告连续数据，并报告 95%置信区间（95%CI）和相应的 P 值。使用推荐分级、评估、制定和评估（GRADE）方法评估证据的可信度。我们将最大血糖水平测量和 24 小时内的基线变化作为主要结局；将血糖水平测量和地塞米松给药后 2、4、8、12 和 24 小时的基线变化作为次要结局。
我们纳入了 23 项 RCT，共纳入 11154 名参与者。与对照组相比，地塞米松在所有时间点的血糖水平均显著升高。结果显示，与对照组相比，地塞米松在 2 小时时升高了 0.37 mmol/L（6.7 mg/dL）（95%CI，0.16-0.58 mmol/L 或 2.9-10.5 mg/dL），在 4 小时时升高了 0.97 mmol/L（17.5 mg/dL）（95%CI，0.67-1.25 mmol/L 或 12.1-22.5 mg/dL），在 8 小时时升高了 0.96 mmol/L（17.3 mg/dL）（95%CI，0.55-1.36 mmol/L 或 9.9-24.5 mg/dL），在 12 小时时升高了 0.90 mmol/L（16.2 mg/dL）（95%CI，0.62-1.19 mmol/L 或 11.2-21.4 mg/dL），在 24 小时时升高了 0.59 mmol/L（10.6 mg/dL）（95%CI，0.22-0.96 mmol/L 或 4.0-17.3 mg/dL）。除了 2 项（24 小时内最大血糖水平变化和 4 小时内变化）和 2 项地塞米松剂量（4-5 mg 与 8-10 mg）外，在所有其他结局中，在所有结局中，均未发现糖尿病状态（糖尿病患者与非糖尿病患者）的亚组之间存在差异。
与对照组相比，麻醉诱导时单次使用地塞米松可使血糖水平在 24 小时内升高 0.37 至 1.63 mmol/L（6.7 至 29.4 mg/dL），但在大多数患者中，这种差异无临床意义。
