Effect of intra-operative single dose of dexamethasone for control of post-operative nausea and vomiting on the control of glucose levels in diabetic patients

Abstract

Background: Dexamethasone adds a unique challenge to glycemic control, and it may complicate patient care if there is an association between intra-operative dexamethasone and blood glucose levels.

Methods: We analyzed 396 diabetic patients who underwent general anesthesia for various surgical procedures and were hospitalized post-operatively for at least 24 h between January 2015 and June 2016. Patients were classified into two groups-those who received dexamethasone intra-operatively and those who did not. The groups were analyzed for blood glucose changes during and following their procedure.

Results: A total of 396 diabetic patients (152 (38.8%) dexamethasone group; 244 (62.2%) control) were included. The dexamethasone group had significantly lower preoperative blood glucose (135.5 mmol/L) compared to the control group (144.4 mmol/L) (p = 0.04) and significantly lower proportion of patients who had received insulin during surgery (14.9%) compared to the control group (23.4%) (p = 0.04). Overall, glucose levels declined from pre-op to post-op day 1 by 9.6 (62.9) (p = 0.007).

Conclusion: Diabetic patients receiving dexamethasone for control of post-operative nausea during surgery are at greater risk for increasing blood glucose levels and difficult glycemic control during and after surgery compared to patients receiving other medications to control post-operative nausea.