Depth of Anesthesia 37: Should intraoperative dexamethasone be avoided in patients with diabetes mellitus?
May 1, 2024
Dr. Caroline Andrew, an anesthesia resident at Massachusetts General Hospital, and Dr. David Nathan, Director of its Diabetes Center and Harvard Medical School Professor, delve into the complex relationship between intraoperative dexamethasone and diabetes. They discuss a case study highlighting elevated blood sugar risks, scrutinize a randomized control trial revealing dexamethasone’s significant impact on post-surgical glucose levels, and emphasize the importance of careful insulin management for diabetic patients, addressing the broader implications for patient outcomes.
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Glucocorticoid Effects
- Glucocorticoids increase gluconeogenesis in the liver and cause insulin resistance.
- They are stress hormones with long-term effects on fat distribution, impacting diabetes.
Dexamethasone and Blood Glucose
- The study by Tien et al. found that dexamethasone increased blood glucose levels in both diabetic and non-diabetic patients.
- This increase was more significant in diabetic patients, especially in terms of change from baseline.
Surgery as a Stress State
- Surgery is a stress state causing steroid production, making comparing dexamethasone's impact complex.
- Dexamethasone provides a steady steroid state, unlike natural diurnal variation.