EVALUATION OF HYPERGLYCAEMIC RESPONSE TO ANTI-EMETIC DOSE OF DEXAMETHASONE IN DIABETIC PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANESTHESIA
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Abstract
Background: To evaluate hyperglycaemic response to anti-emetic dose of dexamethasone in diabetic patients undergoing laparoscopic cholecystectomy.
Materials & methods: A prospective study was conducted on 120 ASA I and II, aged 16-60 years patients posted for laparoscopic cholecystectomy under general anaesthesia. A detailed pre-anesthetic evaluation was carried out to rule out the presence of any significant co-morbidity. Demographic data collected was age, weight, height and BMI. Patient’s HbA1c was also done and recorded. Hyperglycaemia is defined as blood glucose greater than 125 mg/dl while fasting and greater than 180 mg/dl 2 hours postprandial. All the patients were divided into two groups: Group A: 60 diabetic patients and Group B: 60 non-diabetic patients. On the day of surgery a baseline RBS of all the patients was taken and recorded. A standardized general anesthesia technique was used for the two groups.Injection dexamethasone 8mg was given to all the patients in both the groups. Blood glucose levels were estimated for all the patients preoperatively and then at 1,2,3 and 4 hours after giving injection dexamethasone. After surgery, patients were extubated in the operating room. In post-operative care unit patients were evaluated for nausea and vomiting. Post operative pain was assessed by numeric rating scale for pain (0 = no pain, 10= worst possible pain). Data was analysed using Statistical Package for Social Sciences, version 23 (SPSS Inc., Chicago, IL). Student t- test was used for group comparison. A ‘p’ value of less than 0.05 was considered statistically significant.
Results: It was observed that the association of age and weight was significant in both the groups (p<0.05). Age and weight was more in group A patients. The preoperative RBS was also statistically significant in Group A while statistically insignificant in group B. HbA1C and mean RBS also showed statistically significant corelation. The corelation between BMI and mean RBS was found to be statistically significant (p<0.05). There was also no postoperative nausea and vomiting in majority of the patients after Dexamethasone injection.
Conclusion: Antiemetic dose of dexamethasone causes significant rise in blood sugar in diabetic patients but the hyperglycaemic response is not exaggerated beyond expected physiology.Therefore no pharmacological intervention is required.
References
2. Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg. 2013; 257(1):8–14.
3. Swanson CM, Potter DJ, Kongable GL, Cook CB. An Update on Inpatient Glycemic Control in U.S. Hospitals. EndocrPract. 2011:1–22.
4. Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M, Newton CA, Smiley-Byrd D, Vellanki P, Halkos M, Puskas JD, Guyton RA, Thourani VH. Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. Diabetes Care. 2015; (9):1665–1672.
5. Frisch A, Chandra P, Smiley D, Peng L, Rizzo M, Gatfcliffe C, Hudson M, Mendoza J, Johnson R, Lin E, Umpierrez G. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2010; 33(8):1783–1788.
6. Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet. 2009; 373(9677):1798–1807.
7. Greci LS, Kailasam M, Malkani S, Katz DL, Hulinsky I, Ahmadi R, Nawaz H. Utility of HbA(1c) levels for diabetes case finding in hospitalized patients with hyperglycemia. Diabetes Care. 2003; 26(4):1064–1068.
8. Mazurek JA, Hailpern SM, Goring T, Nordin C. Prevalence of Hemoglobin A1c Greater Than 6.5% and 7.0% among Hospitalized Patients without Known Diagnosis of Diabetes at an Urban Inner City Hospital. J Clin Endocrinol Metab. 2010; 95(3):1344–1348.
9. Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, Seley JJ, Van den Berghe G, Endocrine Society. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012; 97(1):16–38.
10. Tien M, Gan TJ, Dhakal IB, White WD, Fink R, Mishriky B. The effect of anti-emetic doses of dexamethasone on postoperative blood glucose levels in non-diabetic and diabetic patients: a prospective randomised controlled study., Anaesthesia 71(9):1037-1043, DOI:10.1111/anae.13544. September 2016.
11. Zou Z, Jiang Y, Xiao M, Zhou R. The Impact of Prophylactic Dexamethasone on Nausea and Vomiting after Thyroidectomy: A Systematic Review and Meta-Analysis. Published: October 16, 2014, https://doi.org/10.1371/journal.pone.0109582
12. Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Shear T, Vender JS. The effect of single low-dose dexamethasone on blood glucose concentrations in the perioperative period: a randomized, placebo-controlled investigation in gynecologic surgical patients. doi: 10.1213/ANE. 0b013e3182a53981. AnesthAnalg 2014 Jun;118(6):1204-12.
13. Gan TJ. Risk factors for postoperative nausea and vomiting. AnesthAnalg2006;102:1884 98.
14. Novacek G. Gender and gallstone disease. Wien Med Wochenschr. 2006 Oct;156(19-20):527-33. doi: 10.1007/s10354-006-0346-x. PMID: 17103289.
15. Hans P, Vanthuyne A, Dewandre PY, Brichant JF, Bonhomme V. Blood glucose concentration profile after 10 mg dexamethasone in non-diabetic and type 2 diabetic patients undergoing abdominal surgery. Br J Anaesth. 2006;97:164-70
16. Mohammeda AH, Ismaila MMA, Mohammed HS. The effect of dexamethasone on postoperative blood glucose levels in diabetic and non-diabetic Patients who are undergoing laparoscopic cholecystectomy. SVU-IJMS, 2020;3(1): 19-24
17. Gülmez DD, Özgültekin AO, Ekinci O, Gülmez M. Effects of peri-operative administration of steroids on the blood glucose levels of patients with and without diabetes undergoing laparoscopic cholecystectomy. J Surg Med. 2018;2(3):249-252. Research article DOI: 10.28982/josam.424450.
18. Nazar CE, Lacassie HJ, López RA, Muñoz HR. Dexamethasone for postoperative nausea and vomiting prophylaxis: Effect on glycaemia in obese patients with impaired glucose tolerance. Europian Journal of Anaesthesiology,2009;26:318-21.
19. Purushothaman AM, Pujari VS, Kadirehally NB, Bevinaguddaiah Y, Reddy PR. A prospective randomized study on the impact of low-dose dexamethasone on perioperative blood glucose concentrations in diabetics and nondiabetics. doi: 10.4103/sja.SJA_409_17,Saudi J Anaesth. 2018 Apr-Jun; 12(2): 198–203.
20. Gupta R, Srivastava S, Dhiraaj S, Chovatiya PP. Minimum effective dose of dexamethasone in combination with midazolam as prophylaxis against postoperative nausea and vomiting after laparoscopic cholecystectomy. Anesth Essays Res 2018;12:396-401.
21. Yeo J, Jung J, Ryu T, Jeon YH, Kim S, Baek W, et al. Antiemetic efficacy of dexamethasone combined with midazolam after middle ear surgery. Otolaryngol Head Neck Surg 2009;141:684 8.
22. El Deeb A, Ali Y, Rashdy H. Evaluation of combination antiemetic prophylaxis in high risk emetogenic patients undergoing thyroid surgery: A randomized double blind study. Egypt J Anaesth 2011;27:203 6.
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Dr. Shailza Joshi
Junior Resident, Department of Anaesthesiology and critical care. SGRRIM & HS, Dehradun, Uttarakhand, India
Dr. Robina Makker
Professor, Department of Anaesthesiology and critical care. SGRRIM & HS, Dehradun, Uttarakhand, India
Dr. Tenzin Kyizom
Associate Professor, Department of Anaesthesiology and critical care. SGRRIM & HS, Dehradun, Uttarakhand, India.
Dr. Saurabh Varshney
Associate Professor, Department of Anaesthesiology and critical care. Gautam Buddha Chikitsa Mahavidhyalaya, Dehradun, Uttarakhand, India.
Dr. Swati Bachhuwan
Assistant Professor, Department of Anaesthesiology and critical care. Gautam Buddha Chikitsa Mahavidhyalaya, Dehradun, Uttarakhand, India