Summary: In a double-blind trial, a single intraoperative dose of dexamethasone raised blood glucose significantly in both diabetic and non-diabetic patients, but no patient exceeded 180 mg/dL, supporting its use for nausea prophylaxis in well-controlled patients.
PICO Summary
| Element | Detail |
|---|---|
| Population | Adult surgical patients, diabetic and non-diabetic, under general anaesthesia; double-blind RCT, India. |
| Intervention | Single dose of dexamethasone at induction (four groups: diabetic and non-diabetic, dexamethasone or saline). |
| Comparison | Saline at the same time point. |
| Outcome | Blood glucose rose more with dexamethasone than saline in both diabetic and non-diabetic groups (p<0.05). No patient exceeded 180 mg/dL at 2 or 8 hours. Dexamethasone reduced postoperative nausea and vomiting in the first 24 hours. |
Expert Commentary
This is a practical, reassuring trial that answers a question anaesthetists and physicians genuinely worry about, and its central virtue is distinguishing statistical from clinical significance. Yes, dexamethasone raised glucose measurably in both diabetic and non-diabetic patients, which is entirely expected given glucocorticoids drive gluconeogenesis and insulin resistance. The clinically meaningful finding is what did not happen: no patient crossed 180 mg/dL, the threshold above which perioperative hyperglycaemia is linked to infection and impaired wound healing. So the glucose effect is real but contained, at least in this population, and the established benefit of reducing postoperative nausea and vomiting is preserved. The crucial caveat, which the trial itself flags, is patient selection: these were well-controlled diabetic patients, and the result cannot be extended to those with poor baseline control whose starting glucose plus a steroid effect could breach the threshold. Can I use this with my patients? Yes, with that boundary. For a well-controlled diabetic patient at risk of nausea and vomiting, I would not withhold a single dexamethasone dose on glucose grounds, while monitoring glucose postoperatively and choosing alternative antiemetics when baseline control is poor.
References
Rose N, Babu SMG, Navaneethan NK, Shruthi KS. The effect of single intraoperative dose of dexamethasone on the blood glucose concentration in diabetic and non-diabetic patients: a double blinded randomized control study. Asian J Anesthesiol. 2024;62(3):153–161. doi:10.6859/aja.202409_62(3).0005