Effect of Single Low-Dose Dexamethasone on Peri-operative Blood Glucose Levels

Authors

  • SA Dada
  • OM Fatungase
  • BB Osinaike
  • OO Olawale
  • AA Ogundipe
  • AB Ojo

DOI:

https://doi.org/10.30442/ahr.1003-04-244

Keywords:

Blood glucose, Combined Spinal-Epidural Anaesthesia, Dexamethasone, Post-operative Nausea and Vomiting

Abstract

Background: Post-operative nausea and vomiting (PONV) is the second most common complaint reported after surgery with an incidence of 30%-80%. PONV is associated with numerous morbidities, hence prevention is beneficial. Dexamethasone is used as a prophylactic anti-emetic agent, however, being a corticosteroid, it could cause hyperglycaemia which is associated with a number of other adverse effects.

Objectives: To study the effect of a single low-dose intravenous dexamethasone given as a prophylactic anti-emetic agent on perioperative blood glucose levels.

Methods: Eighty-eight women who had elective myomectomy or hysterectomy under combined spinal-epidural (CSE) anaesthesia were randomised into two groups of 44 each. Following baseline blood glucose estimation, one group had 4 mg (1 ml) of intravenous dexamethasone 1-2 seconds after blood glucose check while the control group had 1 ml of normal saline. Blood glucose was measured every hour intra-operatively and two-hourly post-operatively till 12 hours after drug administration. Nausea, vomiting, dyspepsia, pain, motor block duration and urinary output were assessed hourly.

Results: The mean maximum change in blood glucose from baseline in the dexamethasone group was statistically significantly higher than in the control group, 51.00±26.57 mg/dl vs. 35.80±25.71 mg/dl (p = 0.007) so also was the mean maximum blood glucose, 153.93±31.63 mg/dl vs. 139.52±28.95 mg/dl (p = 0.028) respectively.

Conclusion: Intravenous dexamethasone at a single, low-dose (4 mg) used as a prophylaxis for nausea and vomiting is associated with significant increase in blood glucose concentration.

References

Parthasarathy P, Babu K, Raghavendra Rao RS, Raghuram S. The effect of single dose intravenous dexamethasone on postoperative nausea and vomiting in patients undergoing surgery under spinal anaesthesia: A double blind randomized clinical study. Anesth Essays Res 2018;12:313-317. DOI: 10.4103/aer.AER_159_17

Smith HS, Smith EJ, Smith BR. Postoperative Nausea and Vomiting; Review Article. Ann Palliat Med. 2012;1:94-102. https://doi.org/10.3978/j.issn.2224-5820.2012.07.05

Hoofnagle JH. LiverTox: A Website on Drug-Induced Liver Injury. In Kaplowitz N, DeLeve LD (Editors). Drug-Induced Liver Disease. Third Edition. Academic Press. 2013.pp725-732. https://doi.org/10.1016/B978-0-12-387817-5.00040-6.

Khan J, Ashraf RA, Bilal Shabbir HM, Haider A, Saeed S, Rauf Khalid A, et al. The Effect of Dexamethasone on Postoperative Pain Management in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial. Cureus 2023;15:e37052. https://doi.org/10.7759/cureus.37052

Soo JS, Ronny P. Dexamethasone Mechanism in Inflammatory Immune Mediated Disease and its application in treating 2019 Coronavirus disease (COVID-19). Med Res Arch 2020;8:1-29. DOI:10.18103/mra.v8i12.2267

Olajumoke TO, Afolayan JM, Fashanu AO, Adekunle MA. Single Dose of Dexamethasone for Prevention of Nausea and Vomiting After Major Gynaecological Surgery. Niger J Med 2013;22:207 -211.

Pierre S, Whelan R. Nausea and vomiting after surgery. Continuing Educ Anaesth Critical Care Pain 2013;13:28-32. https://doi.org/10.1093/bjaceaccp/mks046

De Oliviera GS Jr, Castro-Alves LJ, Ahmad S, Kendall MC, Mc Carthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized control trial. Anesth Analg 2013;116:58-74. DOI: 10.1213/ANE.0b013e31826f0a0a

Low Y, White WD, Habib AS. Postoperative hyperglyceamia after 4mg versus 8-10mg dexamethasone for postoperative nausea and vomiting prophylaxis in patient with Type 2 diabetes mellitus: a retrospective database analysis. J Clin Anesth 2015 ;27:589-594. DOI: 10.1016/j.jclinane.2015.07.003

Tamez-Pérez HE, Quintanilla-Flores DL, Rodríguez-Gutiérrez R, González-González JG, Tamez-Peña AL. Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World J Diabetes 2015;6:1073-1081. https://doi.org/10.4239/wjd.v6.i8.1073

Peter V, Shenoy U, Rukkiyabeevi B. Effect of a single intraoperative dose of dexamethasone on glycaemic profile in postoperative patients - A double-blind randomised controlled study. Indian J Anaesth 2022;66:789-795. https://doi.org/10.4103/ija.ija_332_22

Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Shear T, Vender JS, et al. The effect of single low-dose dexamethasone on blood glucose concentrations in the peri-operative period: A randomized, placebo-controlled investigation in gynecologic surgical patients. Anesth Analg 2014;118:1204-1212. https://doi.org/10.1213/ANE.0b013e3182a53981

Duggan EW, Carlson K, Umpierrez GE. Perioperative hyperglycemia management: an update. Anesthesiology. 2017;126:547-560. https://doi.org/10.1097/aln.0000000000001515.

Charan J, Bisiwas T. How to calculate sample size for different study design in medical research. Indian J Psychol Med 2013;35:121-126. DOI: 10.4103/0253-7176.116232

Abdelmalak BB, Bonilla AM, Yang D, Chowdary HT, Sesslar DI. The hyperglycemic response to major non-cardiac surgery and the added effect of steroid administration in patient with and without Diabetes. Anesth Analg 2013;116:1116–1122. https://doi.org/10.1213/ANE.0b013e318288416d

Chalifoux F, Colin F, St-Pierre P,Godin N, Brulotte V. Low dose intravenous dexamethasone (4 mg and 10 mg) significantly prolongs the analgesic duration of single-shot interscalene block after arthroscopic shoulder surgery: a prospective randomized placebo-controlled study. Can J Anesth 2017;64:280–289. https://doi.org/10.1007/s12630-016-0796-6

Peter V, Shenoy U, Rukkiyabeevi B. Effect of a single intra-operative dose of dexamethasone on glycaemic profile in postoperative patients - A double-blind randomised controlled study. Indian J Anaesth 2022;66:789-795. https://doi.org/10.4103/ija.ija_332_22

Khatiwada S, Bhattarai B, Biswas BK, Pokharel K, Acharya R, Singh SN, et al. Postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under subarachnoid block: a randomized study of dexamethasone prophylaxis. Kathmandu Univ Med J 2012;10:41-45. https://doi.org/10.3126/kumj.v10i2.7342

Mehdirratta JE, Dominguez JE, Li Y, Saab R, Ashraf SH, Allen TK. Dexamethasone as an Analgesic Adjunct for Postcesarean Delivery Pain: A Randomized Controlled Trial. Anaesthesiol Res Pract 2021;4750149.doi.org/10.1155/2021/4750149.

Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative Dexamethasone on postoperative analgesia and side-effects; A systematic review and meta-analysis. Br J Anaesth 2013;1:191-200. DOI: 10.1093/bja/aes431

Sourabh R, Soma D. Effect of intravenous dexamethasone on spinal anaesthesia with bupivacaine plus fentanyl in patients undergoing vaginal hysterectomy. IOSR-JDMS 2017;16:24-28. DOI:10.9790/0853-1603062428

Shalu PS, Ghodki PS. To study the efficacy of intravenous dexamethasone in prolonging the duration of spinal anesthesia in elective cesarean section. Anesth Essays Res 2017;11:321–325. DOI: 10.4103/0259-1162.194537

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Published

2024-09-29

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Original Research

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