Intraoperative Dexamethasone Dosing in Type II Diabetic Patients

Abstract

Purpose: Identifying trends in the intraoperative dosing of dexamethasone in type II diabetic patients undergoing genitourinary, orthopedic, or bariatric procedures at a community hospital to determine impact of the dose received on perioperative glycemic control.

Background: Dexamethasone is a corticosteroid and despite its many documented benefits when administered perioperatively to surgical patients, it is often withheld in the type II diabetic population out of concern for postoperative hyperglycemia.

Methods: Retrospective chart reviews of 156 type II diabetics receiving dexamethasone undergoing bariatric, orthopedic, or genitourinary procedures were completed. Data inclusion criteria: type II diabetics, procedures <4 hours, HbA1C reading 6.5-8.9%, non-pregnant, ASA status I, II, or III, & not taking steroidal medications.

Results: Of the 156 perioperative glycemic trends reviewed, there was a significant increase between the preoperative and immediate postoperative blood glucose readings in bariatric (n=36, t = 8.72, p<0.001) and orthopedic (n=70, t=4.16, p<0.001). There was not a significant increase of blood glucose in genitourinary patients (n=49, t= 0.92, p=0.361).

Conclusion: Dexamethasone increases postoperative BG significantly in type II diabetic patients undergoing bariatric and orthopedic surgery in the immediate postoperative period. There was not a significant increase in patients undergoing genitourinary procedures. This finding may be a
result of a shorter length of surgery. The dose itself did not have any effect on the significance of blood glucose increase, except in the orthopedic group at 10 mg.

Keywords: Hemoglobin A1C (HbA1C), dexamethasone, diabetic II, type 2, bariatric, orthopedic, genitourinary, intraoperative

Presentation

Biography

Morgan Pullium, BSN, RN

Morgan Pullium BSN, RN received her Bachelor of Science in Nursing from East Carolina University and is scheduled to receive her DNP in May of 2024.

Natatalie Gabhart, BSN, RN

Natatalie Gabhart, BSN, RN received her Bachelor of Science in Nursing from Bellarmine University and is scheduled to receive her DNP in May of 2024.

Sarah Lynn Walker, BSN, RN

Sarah Lynn Walker, BSN, RN received her Bachelor of Science in Nursing from The University of Alabama and is scheduled to receive her DNP in May of 2024.

Faculty Committee Advisor(s)

Stephanie Woods, PhD, RN

Danielle Brown, DNP, CRNA

Catherine Helms, PharmD

Suzanne Boyd, PhD, MSW, ACSW, FNAP

Katie Shue-McGuffin, DNP, MSN, APRN, FNP-C