title: Randomised controlled trial of the effect of oral premedication with dexamethasone on hyperglycaemic response to abdominal hysterectomy.
abstract: BACKGROUND
  This study was performed to evaluate the metabolic effects of a single oral dose of 8 mg dexamethasone in women undergoing hysterectomy.
  
  
  METHODS
  Ninety non-diabetic women undergoing abdominal hysterectomy were randomised to receive 8 mg dexamethasone or placebo 2 h before surgery. Patients' perioperative care was standardised (fasting from midnight before surgery, balanced anaesthesia using propofol, fentanyl, remifentanil, cisatracurium, desflurane in oxygen/air). At five defined time points after drug administration (approximately 2, 4, 6, 10 and 14 h), blood samples were drawn under fasting conditions to measure blood glucose and free (non-esterified) fatty acids (NEFA). Data were analysed using analysis of variance for repeated measures.
  
  
  RESULTS
  Data of 82 patients (dexamethasone: 44 and placebo: 38) were eligible for analysis. There was a statistically significant increase in blood glucose in both groups (P = 0.008). This increase was more pronounced in patients receiving dexamethasone (interaction term: P = 0.02) with maximum values at 6 h after surgery (or approximately 10 h after dexamethasone administration). There were 36 patients (placebo: 9 = 24% and dexamethasone: 27 = 61%) presenting with elevated glucose concentrations (>7 mmol l⁻¹) and 11 patients (placebo: 2 = 5% and dexamethasone: 9 = 20%) with hyperglycaemia (>8.5 mmol l⁻¹). There were no statistically significant changes in the plasma concentrations of NEFA during the perioperative period.
  
  
  CONCLUSIONS
  Amounts of dexamethasone frequently used for prophylaxis of post-operative nausea and vomiting can cause short-lasting hyperglycaemia in the post-operative period, but no relevant alterations in fat metabolism. Thus, the benefits of administering corticosteroids should be weighed against the potential side-effects of short-lasting hyperglycaemia.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Philipps University of Marburg, Baldingerstraße, D-35033 Marburg, Germany. eberhart@staff.uni-marburg.de
authors.forename: Leopold H J
authors.initials: LH
authors.lastname: Eberhart
authors.forename: Jürgen
authors.initials: J
authors.lastname: Graf
authors.forename: Astrid M
authors.initials: AM
authors.lastname: Morin
authors.forename: Thomas
authors.initials: T
authors.lastname: Stief
authors.forename: Matthias
authors.initials: M
authors.lastname: Kalder
authors.forename: Ralph
authors.initials: R
authors.lastname: Lattermann
authors.forename: Thomas
authors.initials: T
authors.lastname: Schricker
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000009:adverse effects / Q000494:pharmacology*; D001786:Blood Glucose / Q000187:drug effects; D003907:Dexamethasone / Q000009:adverse effects / Q000494:pharmacology*; D004311:Double-Blind Method; D005230:Fatty Acids, Nonesterified / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced*; D007044:Hysterectomy / Q000379:methods; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011292:Premedication / Q000379:methods; D013997:Time Factors
chemical_list: D000932:Antiemetics; D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D005938:Glucocorticoids; D003907:Dexamethasone