• Tomás B Corcoran, Edmond O'Loughlin, ChanMatthew T VMTV, and Kwok M Ho.
• From the Department of Anaesthesia and Pain Medicine, Royal Perth Hospital (TBC), School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia (TBC, EOL), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria (TBC), Department of Anaesthesia and Pain Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia (EOL), Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China (MAC), Department of Intensive Care Medicine, Royal Perth Hospital (KMH), Medical School, University of Western Australia (KMH) and School of Veterinary & Life Sciences, Murdoch University, Perth, Western Australia, Australia (KMH).
• Eur J Anaesthesiol. 2021 Sep 1; 38 (9): 932-942.

BackgroundThe hyperglycaemic effect of dexamethasone in diabetic and nondiabetic patients in the peri-operative period is unknown.ObjectiveTo assess the effect of a single dose of intra-operative dexamethasone on peri-operative blood glucose.DesignMulticentre, stratified, randomised trial.SettingUniversity hospitals in Australia and Hong Kong.PatientsA total of 302 adults scheduled for elective, noncardiac and nonobstetric surgical procedures under general anaesthesia, stratified by diabetes mellitus status, were randomised to receive placebo, 4 or 8 mg dexamethasone administered intravenously after induction of anaesthesia.Main Outcome MeasuresMaximum blood glucose within 24 h of surgery, and the interaction between glycated haemoglobin (HbA1c) and dexamethasone were the primary and secondary outcomes.ResultsThe median [IQR] baseline blood glucose in the nondiabetes stratum in the placebo (n=81), 4 mg (n=81) and 8 mg dexamethasone (n=77) trial arms were respectively 5.3 [4.6 to 5.8], 5.0 [4.7 to 5.4] and 5.0 [4.2 to 5.9] mmol l-1. In the diabetes stratum these values were 6.6 [6.0 to 8.3]; (n=22), 6.1 [5.5 to 10.4]; (n=22) and 6.7 [5.6 to 8.3]; (n=19) mmol l-1. The median [IQR] maximum peri-operative blood glucose values in the nondiabetes stratum were 6.0 [5.3 to 6.8], 6.3 [5.5 to 7.3] and 6.3 [5.8 to 7.4] mmol l-1 in the control, dexamethasone 4 mg and dexamethasone 8 mg arms, respectively. In the diabetes stratum these values were 10.3 [8.1 to 12.4], 12.6 [10.3 to 18.3] and 13.6 [11.2 to 20.1] mmol l-1. There was a significant interaction between pre-operative HbA1c value and 8 mg dexamethasone: every 1% increment in HbA1c produced a 4.0 mmol l-1 elevation in maximal peri-operative glucose concentration.ConclusionDexamethasone 4 mg or 8 mg did not induce greater hyperglycaemia compared with placebo for nondiabetic and well controlled diabetic patients. Maximal peri-operative blood glucose concentrations in patients with diabetes were related to baseline HbA1c values in a concentration-dependent fashion after 8 mg of dexamethasone.Trial RegistrationAustralia and New Zealand Clinical Trials Registry (ACTRN12614001145695): URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367272.Copyright © 2020 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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