Intra-operative dexamethasone (4 mg or 8 mg) did not induce greater hyperglycaemia compared with placebo in nondiabetic and well-controlled diabetic patients undergoing noncardiac surgery.
RCT (n=302)
stratified
Yes
Does intravenous dexamethasone increase maximum blood glucose within 24 hours in adults undergoing elective non-cardiac surgery?
Intravenous dexamethasone (4 mg or 8 mg) does not induce greater hyperglycemia compared with placebo in nondiabetic and well-controlled diabetic patients, but higher baseline HbA1c predicts significant hyperglycemia with 8 mg dexamethasone.
BACKGROUND: The hyperglycaemic effect of dexamethasone in diabetic and nondiabetic patients in the peri-operative period is unknown. OBJECTIVE: To assess the effect of a single dose of intra-operative dexamethasone on peri-operative blood glucose. DESIGN: Multicentre, stratified, randomised trial. SETTING: University hospitals in Australia and Hong Kong. PATIENTS: A total of 302 adults scheduled for elective, noncardiac and nonobstetric surgical procedures under general anaesthesia, stratified by diabetes mellitus status, were randomised to receive placebo, 4 or 8 mg dexamethasone administered intravenously after induction of anaesthesia. MAIN OUTCOME MEASURES: Maximum blood glucose within 24 h of surgery, and the interaction between glycated haemoglobin (HbA1c) and dexamethasone were the primary and secondary outcomes. RESULTS: The median IQR baseline blood glucose in the nondiabetes stratum in the placebo (n=81), 4 mg (n=81) and 8 mg dexamethasone (n=77) trial arms were respectively 5.3 4.6 to 5.8, 5.0 4.7 to 5.4 and 5.0 4.2 to 5.9 mmol l-1. In the diabetes stratum these values were 6.6 6.0 to 8.3; (n=22), 6.1 5.5 to 10.4; (n=22) and 6.7 5.6 to 8.3; (n=19) mmol l-1. The median IQR maximum peri-operative blood glucose values in the nondiabetes stratum were 6.0 5.3 to 6.8, 6.3 5.5 to 7.3 and 6.3 5.8 to 7.4 mmol l-1 in the control, dexamethasone 4 mg and dexamethasone 8 mg arms, respectively. In the diabetes stratum these values were 10.3 8.1 to 12.4, 12.6 10.3 to 18.3 and 13.6 11.2 to 20.1 mmol l-1. There was a significant interaction between pre-operative HbA1c value and 8 mg dexamethasone: every 1% increment in HbA1c produced a 4.0 mmol l-1 elevation in maximal peri-operative glucose concentration. CONCLUSION: Dexamethasone 4 mg or 8 mg did not induce greater hyperglycaemia compared with placebo for nondiabetic and well controlled diabetic patients. Maximal peri-operative blood glucose concentrations in patients with diabetes were related to baseline HbA1c values in a concentration-dependent fashion after 8 mg of dexamethasone. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry (ACTRN12614001145695): URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367272.
Corcoran et al. (Fri,) conducted a rct in elective noncardiac surgery (n=302). Dexamethasone vs. Placebo was evaluated on Maximum blood glucose within 24 h of surgery. Intra-operative dexamethasone (4 mg or 8 mg) did not induce greater hyperglycaemia compared with placebo in nondiabetic and well-controlled diabetic patients undergoing noncardiac surgery.