Emphasize effect of hyperglycemia by perioperative dexamethasone in diabetic patients

The purpose of this study review was to elucidate the most appropriate preoperative dose of dexamethasone for diabetic patients.

Diabetes is a disease with a high incidence on the Island, since 16% of the Puerto Rican population suffers from it. Photo: Shutterstock.

A review study conducted between Puerto Rico and universities in the United States maintains that the evidence suggests that the patients diabetics receiving dexamethasone in the perioperative period are more likely to develop hyperglycemia, with an increased blood glucose peak 30 to 45 mg/dL in the first 24 hours after a dose only.

The objective of the same explains that the perioperative administration of a single dose of dexamethasone in this population of patients helps to reduce postoperative nausea, vomiting, inflammation and pain.

However, he maintains that it is not clear which dose achieves these effects, while minimizing hyperglycemic impact on patients with diabetes.

Precisely the team decided to carry out the study seeking to elucidate the dose most appropriate perioperative administration of dexamethasone for diabetic patients and if necessary suspend it in patients with poor glycemic control.

The methodology included a literature search using PubMed and the Cochrane Database of Systematic Reviews, which revealed 17 possible sources of evidence. Some eight sources met the inclusion criteria. The sources included a systematic review with meta-analysis, one randomized controlled trial and six observational studies.

One study described elevated levels of blood glucose with dose increasing, but no other source has supported this finding. Available studies were markedly heterogeneous in both design and proportion of diabetic subjects included, and most were of low quality.

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Although the study has its recommendations on the use of this medication, it also emphasizes that there is insufficient evidence to quantify the hyperglycemic effect of commonly used doses of dexamethasone, and rigorous studies are needed.

The literature holds that the dexamethasone plays an important role in the control of postoperative nausea and vomiting, since it has shown great efficacy; however, its use in diabetic patients is cautious, and anesthesiologists have avoided its use due to the increase in plasma glucose.

Dexamethasone is a steroid drug that controls the inflammation process, as it resurfaced again during the arrival of the COVID-19 pandemic.

Diabetes is a disease with a high incidence on the Island, since 16% of the Puerto Rican population suffers from it, according to endocrinologists in the country.

Access the study published by the Journal of Perianesthesia Nursing ASPAN here.