Potential glycemic ramifications of dose-dependent dexamethasone treatment during intracranial procedures
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Abstract
BACKGROUND: Dexamethasone (DEX) is a popular glucocorticoid agent routinely used in clinical settings for its antiemetic, anti-inflammatory, and immunomodulatory effects. Recent literature links administering large doses of DEX for prolonged periods of time with an increased risk of severe intraoperative hyperglycemia (SIH) (serum glucose ≥180 mg/dL) among patients (Gruenbaum et al. 2017). A similar relationship has not been established in patients who receive a large dose of DEX once during the induction stage of anesthesia.
OBJECTIVES: This research thesis investigated the impact of DEX dose on blood glucose fluctuations and the incidence of hyperglycemia in adult neurosurgical patients.
METHODS: This was a retrospective chart review in which data of standard neurosurgical care collected for clinical purposes were quantitatively analyzed. Patients between the ages of 18-89 that underwent intracranial interventions at Boston Medical Center from 2018-2019 were eligible. Perioperative blood glucose concentrations for up to two postoperative days and additional data were gathered from the electronic medical record of each patient.
RESULTS: A total of 106 eligible patients were enrolled in the study. Forty-two patients were not intraoperatively administered DEX (No-DEX group), twenty-one patients received up to 9 mg of DEX (Low-DEX group), and forty-three patients received greater than 9 mg of DEX (High-DEX group). It was determined that the dose of intraoperatively administered DEX had no significant impact on perioperative blood glucose fluctuations (〖Pr[>|t|]〗_Low=0.550; 〖Pr[>|t|]〗_High=0.821), or on the incidence of hyperglycemia (p value=0.803).
CONCLUSION: In neurosurgery patients, significant changes in blood glucose levels and the incidence of perioperative hyperglycemia are not independently associated with the dose of DEX. Hence, the intraoperative administration of a single, large dose of DEX is unlikely to cause more harm to patients than a single, small dose of the drug. However, due to the retrospective nature of the study, small group sample sizes, and use of convenience sampling the results of this study may lack sufficient statistical power and limited representation of the broader population of neurosurgery patients.