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

Discussion

Present study found that application of dexmedetomidine had no effect on blood glucose hemostasis in elderly patients undergoing non-cardiac major surgery.

Hyperglycemia has been proposed highly related with poor patient's outcome, but the definition of intraoperative hyperglycemia is still inconclusive.[3,5–10] The following criteria has been used in literatures, such as ≥ 8.3 mmol/L, ≥ 10 mmol/L, and ≥ 11.1 mmol/L.[5,24,25,27] The difference in definition significantly influences the homogeneity of results. In present study, we adopted 10 mmol/L as the cut-off point to diagnose intraoperative glycemia in line with guidelines and expert consensus.[24,25]

The effect of dexmedetomidine on intraoperative blood glucose is still uncertain. One meta-analysis showed that infusion of dexmedetomidine could decrease intraoperative blood glucose levels with a mean difference of 1 mmol/L in comparison with control groups, but these results presented significant heterogeneity (I2 = 97%).[17] In a pilot study of diabetic patient, intraoperative dexmedetomidine infusion maintained blood glucose levels at a constant level with reference to baseline within 24 h postoperatively and lowered the incidence of hyperglycemia in comparison with control group.[15] We also noticed that the median value of glycemic variation was slightly lower than that of control group (median difference 0.1 mmol/L) in present study, but this seemed to be no clinical relevance.

The association between dexmedetomidine and blood glucose can be influenced by the following factors. First, the effect of dexmedetomidine on blood glucose is dose dependent. In patients undergoing abdominal surgery, patients were divided into three groups and received low, medium and high dosages of dexmedetomidine respectively.[18] In low dosage group, perioperative blood glucose were well regulated in non-diabetic patients whereas higher dosages of dexmedetomidine increased the incidence of hyperglycemia and bradycardia.[18] Evidences in pediatric patients also showed that the elevation of glucose is depended on the dosage of dexmedetomidine.[19] Second, dexmedetomidine could stimulate glucose elevation via α-2A receptor which might overweight its effect of stress alleviation.[21,22] Third, high dose of dexmedetomidine increased the risk of adverse events (such as hypotension and severe bradycardia) which might induce marked hyperglycemia.[28]

In present study, we found that history of diabetics, higher baseline blood glucose and prolonged surgery time were independent risk factors of intraoperative risk factors. This result was also supported by other studies.[29]

Strength of present study was a relatively large sample size than previous studies.[17] We also conducted subgroup analysis to analyze the relationship between dexmedetomidine and blood glucose in different populations.

One limitation was that we excluded patients who were not suitable to receive dexmedetomidine, such as severe arrythmia and hepatic dysfunction. This excluded patients with severe disease and limited the generality of our result. Another limitation was that postoperative blood glucose was not analyzed.

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