RESUMEN
BACKGROUND: Postoperative nausea and vomiting (PONV) prophylaxis with dexamethasone may produce significant hyperglycemia in the postoperative period. AIM: To evaluate if this effect is of greater severity in type 2 diabetics compared with non-diabetic patients. MATERIAL AND METHODS: Forty non-diabetic and thirty type 2 diabetic patients undergoing laparoscopic cholecystectomy were studied in a prospective and double-blind fashion manner. Patients were randomly distributed into 4 groups: Group I, non-diabetics control (n = 20), Group II, non-diabetics dexamethasone (n = 20), Group III, type 2 diabetics control (n = 15), and Group IV, type 2 diabetics dexamethasone (n = 15). Immediately after induction, patients in groups I and III received isotonic saline and patients in the dexamethasone groups received 8 mg i.v. of the steroid. Capillary blood glucose concentrations were measured at baseline and every 2 hours during the first 12 hours since the start of surgery. A linear mixed effect model, adjusted for baseline capillary glucose concentration, age and duration of surgery was used to analyze the data. RESULTS: No effect of the presence of diabetes mellitus was observed in the evolution of glucose concentrations. There was a difference in capillary glucose concentrations between patients who received dexamethasone and placebo that started 2 hours post-intervention, reaching a mean maximum difference of 34 mg/dl (adjusted model, p < 0.001) at 10 hours post-intervention. CONCLUSIONS: In this study, Type 2 diabetic patients did not show a higher susceptibility than non-diabetics to develop postoperative hyperglycemia after the use of prophylactic dexamethasone for PONV.
Asunto(s)
Antieméticos/efectos adversos , Glucemia/efectos de los fármacos , Dexametasona/efectos adversos , Diabetes Mellitus Tipo 2/metabolismo , Hiperglucemia/inducido químicamente , Náusea y Vómito Posoperatorios/prevención & control , Adulto , Glucemia/metabolismo , Colecistectomía Laparoscópica/efectos adversos , Diabetes Mellitus Tipo 2/cirugía , Métodos Epidemiológicos , Femenino , Humanos , Hiperglucemia/diagnóstico , Masculino , Persona de Mediana EdadRESUMEN
Background: Postoperative nausea and vomiting (PONV) prophylaxis with dexamethasone may produce significant hyperglycemia in the postoperative period. Aim: To evaluate if this effect is of greater severity in type 2 diabetics compared with non-diabetic patients. Material and Methods: Forty non-diabetic and thirty type 2 diabetic patients undergoing laparoscopic cholecystectomy were studied in a prospective and double-blind fashion manner. Patients were randomly distributed into 4 groups: Group I, non-diabetics control (n = 20), Group II, non-diabetics dexamethasone (n = 20), Group III, type 2 diabetics control (n = 15), and Group I V, type 2 diabetics dexamethasone (n = 15). Immediately after induction, patients in groups I and III received isotonic saline and patients in the dexamethasone groups received 8 mg iv of the steroid. Capillary blood glucose concentrations were measured at baseline and every 2 hours during the first 12 hours since the start of surgery. A linear mixed effect model, adjusted for baseline capillary glucose concentration, age and duration of surgery was used to analyze the data. Results: No effect of the presence of diabetes mellitus was observed in the evolution of glucose concentrations. There was a difference in capillary glucose concentrations between patients who received dexamethasone and placebo that started 2 hours post-intervention, reaching a mean maximum difference of 34 mg/dl (adjusted model, p < 0.001) at 10 hours post-intervention. Conclusions: In this study, Type 2 diabetic patients did not show a higher susceptibility than non-diabetics to develop postoperative hyperglycemia after the use of prophylactic dexamethasone for PONV.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antieméticos/efectos adversos , Glucemia/efectos de los fármacos , Dexametasona/efectos adversos , /metabolismo , Hiperglucemia/inducido químicamente , Náusea y Vómito Posoperatorios/prevención & control , Glucemia/metabolismo , Colecistectomía Laparoscópica/efectos adversos , /cirugía , Métodos Epidemiológicos , Hiperglucemia/diagnósticoRESUMEN
BACKGROUND AND OBJECTIVE: Dexamethasone given to prevent postoperative nausea and vomiting may produce significant hyperglycaemia in the perioperative period. The effect of dexamethasone on patients with impaired glucose tolerance is unknown. METHODS: Thirty obese patients with impaired glucose tolerance undergoing laparoscopic Roux-en-Y gastric bypass surgery were studied in a double-blind fashion. Patients were randomly distributed into two groups: the dexamethasone group (n = 15) received dexamethasone 8 mg intravenously after induction of anaesthesia; the control group (n = 15) received isotonic saline. Fingerprick capillary blood glucose concentrations were measured at baseline and every 2 h during the first 12 h after the start of surgery. RESULTS: In both groups, all blood glucose concentrations measured after the beginning of surgery were higher than baseline values. However, the dexamethasone group showed higher glucose concentrations than the control group from the 6th to the 12th hour of the study. In addition, the maximum blood glucose value in the dexamethasone group (10.4 +/- 1.6 mmol l(-1)) was higher than in the controls (8.8 +/- 1.7 mmol l(-1)) (P < 0.05). CONCLUSION: Dexamethasone, 8 mg, intravenously administered at the beginning of laparoscopic bariatric surgery in patients with impaired glucose tolerance is associated with significantly increased postoperative blood glucose concentrations.