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

Results

Participants

During study period, a total of 620 patients were enrolled and randomized (Figure 1). In dexmedetomidine group, 1 patient withdrew consent before administration of study drug and 6 patients had no record of intraoperative blood glucose. In the control group, 4 patients had no record of intraoperative blood glucose. Modification of infusion rate of study drug happened in 13 patients in dexmedetomidine group and 8 patients in control group (P = 0.257). One patient in the control group died on postoperative day 28.

Figure 1.

Flowchart of present study

Baseline variables were comparable between the two groups (Table 1). Patients in dexmedetomidine group consumed less dosage of propofol and sufentanil than in control group (P < 0.001 and P = 0.012, respectively), whereas anesthesia depth was similar between the two groups (P = 0.149), Table 2. Urine output was higher in dexmedetomidine group than in control group (P < 0.001), Table 2.

Primary Outcome

The median of highest blood glucose in dexmedetomidine group was 8.7 (IQR 7.7–10.2) mmol/L whereas 8.4 (IQR 7.1–9.8) mmol/L in control group (P = 0.474). The incidence of intraoperative hyperglycaemia was about 27.4% (83/303) in dexmedetomidine group which had no statistical difference in comparison with 22.5% (69/306) of control group (RR 1.22, 95%CI 0.92–1.60, P = 0.167), Figure 2. The result was similar in per protocol analysis, 27.9% (81/290) in dexmedetomidine group vs. 22.5% (67/298) in control group, RR = 1.242, 95%CI 0.939–1.644, P = 0.128.

Figure 2.

Subgroup analysis of primary outcome. There were no significant interactions between dexmedetomidine and hyperglycemia, even in subgroup analysis of any predefined factors, i.e. sex, age, history of diabetic, site of surgery and type of surgery type (All P value > 0.05). DEX = dexmedetomidine; CI = confidence interval

In subgroup analysis, there was no significant relationship between dexmedetomidine and hyperglycaemia on predefined factors, i.e., sex, age, history of diabetic, site of surgery and type of surgery type, Figure 2.

Intraoperative Glycemic Variation

The median of glycemic variation in dexmedetomidine group was slightly less than that of control group (2.5 vs. 2.6 mmol/L, P = 0.034). The magnitude of glycemic variation was divided into six range groups. The frequencies were presented in Figure 3 and showed no statistical difference between two groups (P = 0.581).

Figure 3.

Intraoperative glycemic variability. The magnitude of intraoperative glycemic variability was divided into 6 groups and the frequencies showed no statistical difference between two groups (P = 0.581)

Risk Factors of Intraoperative Hyperglycaemia

Both in univariate and multivariate analysis, use of dexmedetomidine was not related with hyperglycaemia (OR 1.322, 95%CI 0.881–1.983, P = 0.178), Table 3. History of diabetics (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 for intraoperative hyperglycemia.

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