title: Postoperative hyperglycemia after 4- vs 8-10-mg dexamethasone for postoperative nausea and vomiting prophylaxis in patients with type II diabetes mellitus: a retrospective database analysis.
abstract: OBJECTIVE
  The study objective is to compare change in postoperative blood glucose from preoperative values in patients with type II diabetes mellitus receiving 4- or 8-10-mg dexamethasone for postoperative nausea and vomiting prophylaxis.
  
  
  METHODS
  This is a retrospective database study.
  
  
  METHODS
  The setting is at an academic university medical center.
  
  
  METHODS
  There are 1037 adult patients, American Society of Anesthesiologists physical status I-IV, with type II diabetes mellitus, undergoing elective surgery between January 1, 2006, and March 31, 2012, and who were hospitalized for at least 24 hours.
  
  
  METHODS
  The interventions are dexamethasone 4 or 8-10 mg for postoperative nausea and vomiting prophylaxis.
  
  
  METHODS
  Age, sex, American Society of Anesthesiologists class, height, weight, body mass index, surgery date, type and duration of surgery, hemoglobin A1c (HbA1c) within 180 days of surgery, type of anesthesia, preoperative blood glucose in the preoperative holding area, maximum blood glucose in the postanesthesia care unit (PACU) and first 24 hours postoperatively, and insulin requirements intraoperatively and in PACU.
  
  
  RESULTS
  In unadjusted analysis, the 8-10-mg dose was associated with greater (mean ± SD) increase in blood glucose compared with the 4-mg dose in PACU (58 ± 50 vs 43 ± 45 mg/dL, P < .0001) and over 24 hours (101 ± 71 vs 67 ± 65 mg/dL, P < .0001). In the multivariable model, predictors of blood glucose increase in PACU included dexamethasone dose (P < .0001), preoperative serum glucose (P < .0001), duration of surgery (P < .0001), and total dose of insulin (P < .0001). Over 24 hours, the significant predictors of glucose increase included dexamethasone dose (P < .0001), preoperative blood glucose level (P < .0001), duration of surgery (P < .0001), year of surgery (P = .04), and neurosurgical procedures (P = .02). This model estimates the increase in postoperative glucose to be 25 mg/dL higher over 24 hours with dexamethasone 8-10 mg than with 4 mg (95% confidence limits, 18-32 mg/dL).
  
  
  CONCLUSIONS
  Dexamethasone 8-10 mg is associated with a significantly greater perioperative increase in blood glucose compared with a 4-mg dose.
authors: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
authors: Ying
authors: Y
authors: Low
authors: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
authors: William D
authors: WD
authors: White
authors: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. Electronic address: habib001@dm.duke.edu.
authors: Ashraf S
authors: AS
authors: Habib
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage* / Q000009:adverse effects; D001786:Blood Glucose / Q000187:drug effects; D016208:Databases, Factual; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D000932:Antiemetics; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D003907:Dexamethasone
keywords: Dexamethasone; Hyperglycemia; Postoperative nausea and vomiting