Journal article
Perioperative ADministration of Dexamethasone and blood glucose concentrations in patients undergoing elective non-cardiac surgery – the randomised controlled PADDAG trial
European Journal of Anaesthesiology, Vol.38(9), pp.932-942
2020
Abstract
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.
Details
- Title
- Perioperative ADministration of Dexamethasone and blood glucose concentrations in patients undergoing elective non-cardiac surgery – the randomised controlled PADDAG trial
- Authors/Creators
- T.B. Corcoran (Author/Creator)E. O’Loughlin (Author/Creator)M.T.V. Chan (Author/Creator)K.M. Ho (Author/Creator)
- Publication Details
- European Journal of Anaesthesiology, Vol.38(9), pp.932-942
- Publisher
- Wolters Kluwer
- Identifiers
- 991005541841807891
- Copyright
- © 2020 European Society of Anaesthesiology and Intensive Care.
- Murdoch Affiliation
- School of Veterinary and Life Sciences
- Language
- English
- Resource Type
- Journal article
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- 1.43 Anesthesiology
- 1.43.1482 Antiemetics
- Web Of Science research areas
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