Effects Of Dexamethasone On Intraoperative Blood Glucose Concentration In Diabetics And Nondiabetics Undergoing Craniotomy

Objective: To compare the effect of single low dose dexamethasone onintraoperative blood glucose concentration in type II diabetics and nondiabeticsundergoing craniotomy for intracranial aneurysm. Discuss the necessity ofmonitoring intraoperative blood glucose in patients with intracranial aneurysm.Methods: Sixty ASA I-II patients scheduled for intracranial aneurysm clippingunder general anesthesia were enrolled,included thirty type2diabetics and thirtynondiabetics. These patients without major organ dysfunction that affectpatient’s life, anemia, Hb＜11g·dL-1, the long-term use of glucocorticoids,contraindication of glucocorticoids, being addicted to sedative or analgetic drugs.Type2diabetics were randomized into two groups: D-dexamethasone group(group DD, n=15) and D-saline group (group DS, n=15), nondiabetics wererandomized into two groups: N-dexamethasone group (group ND, n=15) andN-saline group (group NS, n=15). Dexamethasone10mg (2mL) and saline2mL were administrated intravenously60minutes before surgery respectively.Maintain the stability of circulation system intraoperatively. Arterial bloodglucose were measured before and after treatment and hourly for4hours intraoperatively. And measure the change in glucose from the preoperative tomaximal intraoperative glucose concentration. The intraoperative blood glucosein T2DM were maintained within the range of5.0-11.0mmol· L-1, innondiabetics, the practice of targeting blood glucose levels to less than8.3mmol·L-1. If the intraoperative blood glucose was below the range’s lowerthreshold, the patient infused5%glucose injection to treat the hypoglycemia. IVinsulin was given when the blood glucose exceeded the upper limits of targetingblood glucose range. Then these patients were excluded from this study.Results: The blood glucose increased remarkably in group DD and group ND,while those in group DS and group NS keep stable. Compare with group NS, thebood glucose in group ND increased significantly120min after dosing.180minafter administration, the blood glucose in group DD was more than group DS.For nondiabetics, the mean increase in glucose was more in group ND thangroup NS. However, there was no dexamethasone effect in diabetics.3patients’intraoperative blood glucose exceeded8.3mmol·L-1in group ND, then receivedinsulin infusion，and were excluded from this study. NO hypoglycemia eventswere observed in all objectives.Conclusion: IV single low-dose dexamethasone increased intra-operative bloodglucose concentration markedly in intracranial aneurysm patients. Thedexamethasone-induced hyperglycemic effect was more notable in nondiabetics.Therefore, the increased attention which diabetic patients have traditionallyexperienced should be extended to nondiabetics as well.