The Effect of Dexmedetomidine on Intraoperative Blood Glucose Homeostasis

Secondary Analysis of a Randomized Controlled Trial

Chun-Jing Li; Bo-Jie Wang; Dong-Liang Mu; Dong-Xin Wang

Disclosures

BMC Anesthesiol. 2021;21(139) 

In This Article

Abstract and Introduction

Abstract

Purpose: To investigate the effect of dexmedetomidine on intraoperative blood glucose hemostasis in elderly patients undergoing non-cardiac major surgery.

Methods: This was secondary analysis of a randomized controlled trial. Patients in dexmedetomidine group received a loading dose dexmedetomidine (0.6 μg/kg in 10 min before anaesthesia induction) followed by a continuous infusion (0.5 μg/kg/hr) till 1 h before the end of surgery. Patients in control group received volume-matched normal saline at the same time interval. Primary outcome was the incidence of intraoperative hyperglycemia (blood glucose higher than 10 mmol/L).

Results: 303 patients in dexmedetomidine group and 306 patients in control group were analysed. The incidence of intraoperative hyperglycemia showed no statistical significance between dexmedetomidine group and control group (27.4% vs. 22.5%, RR = 1.22, 95%CI 0.92–1.60, P = 0.167). Median value of glycemic variation in dexmedetomidine group (2.5, IQR 1.4–3.7, mmol) was slightly lower than that in control group (2.6, IQR 1.5–4.0, mmol), P = 0.034. In multivariable logistic analysis, history of diabetes (OR 3.007, 95%CI 1.826–4.950, P < 0.001), higher baseline blood glucose (OR 1.353, 95%CI 1.174–1.560, P < 0.001) and prolonged surgery time (OR 1.197, 95%CI 1.083–1.324, P < 0.001) were independent risk factors of hyperglycaemia.

Conclusions: Dexmedetomidine presented no effect on intraoperative hyperglycemia in elderly patients undergoing major non-cardiac surgery.

Trial registration: Present study was registered at Chinese Clinical Trial Registry on December 1, 2015 (www.chictr.org.cn, registration number ChiCTR-IPR-15007654).

Introduction

Glucose homeostasis is profoundly disrupted in perioperative settings which is mainly manifested as hyperglycemia and glycemic variability.[1] The incidence of intraoperative hyperglycemia varies from 3% in non-diabetic patients to 15.3% in diabetic patients.[2] It reaches up to 49% in patients who undergoing major non-cardiac surgery.[3] More than 90% of patients suffer glycemic variation with a median magnitude of 5.5 mmol/L during surgery.[4] Both hyperglycemia and magnitude of glycemic variation are related with poor patient's outcome, such as increased risk of complications (i.e., delirium, infection, acute kidney injury, atrial fibrillation, and 30-day readmission rate) and mortality.[3,5–10]

Surgery related stress response is considered as the key factor of intraoperative dysglycemia.[11] Surgery enhances sympathetic stimulation and subsequently increases levels of the hormones promoting glycogen synthesis, such as catecholamines, cortisol, glucagon, and growth hormones.[11,12] This escalation leads to an increase in endogenous glucose production via gluconeogenesis and glycogenolysis. Stress response also triggers excessive elevation of circulating proinflammatory cytokines (i.e., interleukins and tumor necrosis factor).[11] These cytokines result in transient insulin resistance and impairment of insulin signaling pathway which impede glucose metabolism and utility.[11,13]

Dexmedetomidine is a highly selective α-2 adrenergic agonist. Available evidences showed that perioperative application of dexmedetomidine could inhibit stress response and decrease the concentration of miscellaneous stress modulators, i.e., catecholamine and cortisol.[14] In surgical patients (i.e., spine and abdominal surgery), dexmedetomidine could decrease the incidence of hyperglycemia and alleviate glycemic variation.[15–17] However, opposing data indicates that the role of dexmedetomidine in glycemic control is uncertain. In a dose–response analysis, lower dose of dexmedetomidine decreased occurrence of hyperglycemia but higher dosage increased the risk of hyperglycemia in patients undergoing major gastrointestinal surgery.[18] This phenomenon was also observed in pediatric surgical patients.[19,20] Animal studies showed that dexmedetomidine elevated glucose level via α-2A adrenoceptor which played an important role in regulation of insulin secretion and sympathetic output.[21,22]

Present study was designed to investigate the effect of intraoperative dexmedetomidine on glucose hemostasis in elderly patients undergoing non-cardiac major surgery.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....