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NEUROSURGICAL ANESTHESIA

Hyperglycemia in Patients Administered Dexamethasone for Craniotomy

Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

Address correspondence and reprint requests to Pirjo H. Manninen, MD, FRCPC, Department of Anesthesia, Toronto Western Hospital, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada. Address e-mail to Pirjo.Manninen{at}uhn.on.ca.

Hyperglycemia should be avoided during neurosurgery in order to decrease the risk of neurological injury. Dexamethasone has been associated with increased blood glucose during surgery. In this prospective, nonrandomized study, we documented the blood glucose concentration changes for 12 h in 34 nondiabetic patients undergoing craniotomy and compared patients who received intraoperative dexamethasone (10 mg IV on induction and 4 mg IV 6 h later), with or without preoperative dexamethasone, with patients who did not receive dexamethasone. Blood glucose concentrations increased from the preinduction value in all groups. Patients not taking dexamethasone before surgery, but who were given it intra- and postoperatively, had the largest peak blood glucose concentrations (11.0 ± 2.0 mmol/L, mean ± sd; P < 0.01) compared with patients who received no dexamethasone (7.8 ± 2.1 mmol/L) or those who had been taking dexamethasone before surgery and continued it during surgery (8.5 ± 1.2 mmol/L). The peak blood glucose concentrations in this group occurred 9 ± 2 h after the induction of anesthesia. We recommend that the blood glucose concentration be monitored for at least 12 h in nondiabetic patients having neurosurgery who are newly administered dexamethasone.

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