Summary: In patients with type 2 diabetes undergoing laparoscopic colorectal cancer resection, low-dose intraoperative dexmedetomidine (0.25 μg/kg/h) gave the steadiest perioperative glucose, while higher doses (0.5 and 0.75 μg/kg/h) paradoxically worsened glycaemic control versus no dexmedetomidine.
PICO Summary
| Element | Detail |
|---|---|
| Population | 80 adults with type 2 diabetes undergoing laparoscopic colorectal cancer radical resection. |
| Intervention | Dexmedetomidine 1 μg/kg load then 0.25 μg/kg/h maintenance (Group D1). |
| Comparison | No dexmedetomidine (Group C), and higher maintenance doses 0.5 μg/kg/h (D2) and 0.75 μg/kg/h (D3). |
| Outcome | D1 showed least glucose fluctuation without significant hyperglycaemia or delayed extubation. D2 and D3 had significantly higher glucose at several timepoints and greater variability than control. |
Expert Commentary
Stress hyperglycaemia in my surgical diabetic patients is a real and under-managed problem, so the idea that an agent already used for sympatholysis might steady intraoperative glucose is mechanistically appealing. What makes this trial genuinely interesting rather than routine is the dose paradox: only the lowest maintenance dose helped, while the higher infusions did worse than no dexmedetomidine at all. That is a useful and slightly counterintuitive lesson, and a reminder that more sympatholysis is not linearly better. I hold it loosely as evidence, though, because this is a single surgery type, the endpoint is glucose stability rather than infection, length of stay, or any outcome a patient experiences, and the sample is small. As an endocrinologist this is also not my lever to pull directly; it belongs to my anaesthetic colleagues. Can I use this with my patients? Indirectly, yes, as something I would flag in a shared perioperative discussion, favouring conservative dexmedetomidine dosing alongside, never instead of, proper glucose monitoring and insulin protocols. I would want the dose-dependent harm signal independently confirmed before it shapes practice.
References
Dai W, Zhou J, Qu L, He K. Effect of dexmedetomidine on perioperative blood glucose regulation in type 2 diabetic patients undergoing laparoscopic colorectal cancer radical resection: a randomised double-blinded controlled trial. Trials. 2025;26(1):362. doi:10.1186/s13063-025-09094-0