Purpose: Identifying trends in the intraoperative dosing of dexamethasone in type II diabetic patients undergoing bariatric procedures at a community hospital to determine impact of the dose received on perioperative glycemic control.
Background: Dexamethasone is a corticosteroid and despite its many documented benefits when administered perioperatively to surgical patients, it is often withheld in the type II diabetic population out of concern for postoperative hyperglycemia.
Methods: Retrospective chart reviews of 36 type II diabetics receiving dexamethasone undergoing bariatric procedures was completed. Inclusion criteria: type II diabetics, procedures <4 hours, patients with a HbA1C reading 6.5-8.9%, patients who are non-pregnant, patients with an ASA classification of I, II, or III, and who are not taking chronic steroids.
Results: Of the 36 perioperative glycemic trends reviewed, there was a significant increase (t = 8.72, p<0.001) between the preoperative and immediate postoperative blood glucose readings for dexamethasone doses 4-10 mg (p <0.011). This increase was not associated with age, HbA1C, or surgery length. The dose level itself did not influence actual BG level changes (t = -.87, p = .390).
Conclusion: Dexamethasone increases postoperative BG significantly in DMII patients undergoing bariatric surgery in the immediate postoperative period. However, it should be noted that there was not a significant difference between preoperative BG and the 24-hour postoperative BG level. Two patients who did not receive dexamethasone also showed an increase in BG that approached significance (p = .060). These results suggest that further study on the effects of dexamethasone dosing and perioperative glycemic control is necessary.
Key words: Hemoglobin A1C (HbA1C), dexamethasone, diabetic II, type 2, bariatric, intraoperative