The Effect of Single Low-Dose Dexamethasone on Blood Glucose Concentrations in the Perioperative Period: A Randomized, Placebo-Controlled Investigation in Gynecologic Surgical Patients

Murphy, Glenn S. MD*; Szokol, Joseph W. MD*; Avram, Michael J. PhD; Greenberg, Steven B. MD*; Shear, Torin MD*; Vender, Jeffery S. MD*; Gray, Jayla BA*; Landry, Elizabeth BA*

doi: 10.1213/ANE.0b013e3182a53981
Ambulatory Anesthesiology: Research Report

BACKGROUND: The effect of single low-dose dexamethasone therapy on perioperative blood glucose concentrations has not been well characterized. In this investigation, we examined the effect of 2 commonly used doses of dexamethasone (4 and 8 mg at induction of anesthesia) on blood glucose concentrations during the first 24 hours after administration.

METHODS: Two hundred women patients were randomized to 1 of 6 groups: Early-control (saline); Early-4 mg (4 mg dexamethasone); Early-8 mg (8 mg dexamethasone); Late-control (saline); Late-4 mg (4 mg dexamethasone); and Late-8 mg (8 mg dexamethasone). Blood glucose concentrations were measured at baseline and 1, 2, 3, and 4 hours after administration in the early groups and at baseline and 8 and 24 hours after administration in the late groups. The incidence of hyperglycemic events (the number of patients with at least 1 blood glucose concentration >180 mg/dL) was determined.

RESULTS: Blood glucose concentrations increased significantly over time in all control and dexamethasone groups (from median baselines of 94 to 102 mg/dL to maximum medians ranging from 141 to 161.5 mg/dL, all P < 0.001). Blood glucose concentrations did not differ significantly between the groups receiving dexamethasone (either 4 or 8 mg) and those receiving saline at any measurement time. The incidence of hyperglycemic events did not differ in any of the early (21%–28%, P = 0.807) or late (13%–24%, P = 0.552) groups.

CONCLUSIONS: Because blood glucose concentrations during the first 24 hours after administration of single low-dose dexamethasone did not differ from those observed after saline administrations, these results suggest clinicians need not avoid using dexamethasone for nausea and vomiting prophylaxis out of concerns related to hyperglycemia.

Published ahead of print December 2, 2013

From the *Department of Anesthesiology, NorthShore University HealthSystem, Evanston; and Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Accepted for publication June 21, 2013.

Published ahead of print December 2, 2013

Funding: Support was provided solely from institutional and/or departmental sources.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Glenn S. Murphy, MD, Department of Anesthesia, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201. Address e-mail to dgmurphy2@yahoo.com.

© 2014 International Anesthesia Research Society