Comparative analysis of perioperative glucocorticoid effects on glycemic response and post-operative outcomes

Objectives: We evaluated the impact of single prophylactic doses of various glucocorticoids on postoperative glucose concentrations and secondary outcomes in patients who underwent elective surgery. Material and Methods: A prospective observational study was conducted on 190 ASA I-II patients, 18-60 year of age, undergoing elective surgery under general anaesthesia. Patients were randomly allocated into 5 groups (n=38) including dexamethasone 8mg (Group D), hydrocortisone 100 mg (Group H), methylprednisolone 1gm (Group M), combination (Group C) and control (Group N). Measurement of blood glucose was performed at 2, 6, 12, and 24 hours after glucocorticoid infusion. Secondary outcomes measured were PONV, pain scores, and shivering. Results: All intervention arms demonstrated a significant hyperglycemia versus controls, and the hyperglycemic effects continued to be prominent at the 12h time point. The combination therapy group had the highest levels of peak glucose (170.2 ± 19.6 mg/dL), whereas the hydrocortisone group showed an intermediary peak glucose (146.2 ± 16.6 mg/dL). Recovery patterns differed substantially: hydrocortisone had the quickest recovery to baseline values (20.4±2.6 h), combination (24.8±3.4 h). Age, BMI, and duration of surgery and other patient-specific factors had significant effects on the patterns of glycemic response. Secondary outcomes indicated that all treatment options were effective, with combined therapy achieving the best results for PONV (78.9% of PONV-free case in comparison to 39.5% in control group) and postoperative pain management. Conclusions: This study demonstrates significant hyperglycemic effects following single doses of perioperative glucocorticoids, with elevations persisting for 20–24 h. Despite their effectiveness for PONV and pain management, the substantial glycemic responses observed warrant judicious use and appropriate monitoring, particularly with combination therapy, which showed the most pronounced effects.