Postoperative blood sugars and use of starches – a reply

We thank Drs. Patel and Fregene for their interest in our study 1. While some studies have reported an increase in blood glucose following the use of hetastarch 2, others did not show a difference in glucose concentrations between those who received hetastarch compared with lactated Ringers's 3 or with gelatin solutions 4. In our study, 34 patients received Hextend® (6% hetastarch in lactated electrolyte solution). Of those, 15 received dexamethasone and 19 received ondansetron. Eighteen patients received volumes of 500 ml or less, whereas 16 patients received volumes over 500 ml. We therefore categorised Hextend administration as 0, 1–500, and > 500 ml. In univariate analysis, the administration of Hextend was not associated with maximum change in blood glucose concentrations at 4 h (p = 0.35) or 24 h (p = 0.46). Adding the Hextend volume to the multivariable analyses for maximum glucose change at 4 h and 24 h did not change the results reported in our original analysis. In this updated analysis, dexamethasone administration was a significant predictor of maximum 4-hour increase in blood glucose (p < 0.01), after adjusting for baseline glucose levels (p < 0.01), diabetic status (p = 0.37), insulin dose (p < 0.01), use of promethazine (p = 0.32), type of surgery (p = 0.04) duration of surgery (p = 0.81), and volume of Hextend (p = 0.71). Similarly, dexamethasone administration was a significant predictor of maximum 24-h postoperative blood glucose increase (p < 0.01), after adjusting for baseline blood glucose levels (p < 0.01), diabetic status (p = 0.02), insulin dose (p < 0.01), use of promethazine (p = 0.57), type of surgery (p = 0.78), duration of surgery (p = 0.29) and Hextend volume (p = 0.60). In conclusion, the administration of 6% hetastarch was not associated with changes in postoperative blood glucose concentration in our study. It is important to note, however, that our study was not designed to address this question.