The Hyperglycemic Response to Major Noncardiac Surgery and the Added Effect of Steroid Administration in Patients With and Without Diabetes

Abstract

Treatment of intraoperative hyperglycemia should account for the hyperglycemic surgical stress response trend depending on the stage of surgery as well as the added effects of steroid administration. Denying steroid prophylaxis for postoperative nausea and vomiting for fear of hyperglycemic response should be reconsidered given the limited effect of steroids on intraoperative blood glucose concentrations.

Analgesia of Combined Femoral Triangle and Obturator Nerve Blockade Is Superior to Local Infiltration Analgesia After Total Knee Arthroplasty With High-Dose Intravenous Dexamethasone

“…However, a single dose is not associated with any documented long-term complications. 13,14,18,19 We did not observe any complications in our study. The adverse effects of glucocorticoids are associated with prolonged use.…”

Intravenous Dexamethasone and Its Effect on Blood Glucose in Adult Nondiabetic Patients undergoing General Anesthesia for Superficial Surgery

“…The patients receiving dexamethasone had a larger percentage increase as compared with the control group. These findings are also in concurrence with Abdelmalak et al 12 They observed an increase in the blood glucose concentrations (86 mg/dL) from the baseline values in patients given dexamethasone, as compared with (58 mg/dL) the patients who did not receive dexamethasone, all patients being nondiabetic. We observed that there is a rise in the blood glucose concentrations in group I patients, which began at 60 minutes and then increased further, but never beyond 200 mg/dL.…”

The intraoperative glycemic response to intravenous insulin during noncardiac surgery: a subanalysis of the DeLiT randomized trial

“…A plausible explanation is that patient response to insulin was masked by the hypermetabolic stress response to surgical tissue injury. Patients undergoing major non-cardiac surgery typically develop a profound perioperative stress response,[32] a reaction that is substantial, but highly variable. This systemic stress response which is associated with an increase in hepatic glucose production and worsened peripheral insulin resistance[33,34] may have exacerbated severe hyperglycemia and insulin unresponsiveness.…”