Estudo comparativo do efeito da dexametasona na glicemia de diabéticos e não-diabéticos em procedimentos sob raquianestesia

Abstract

The effect of a single dose of dexamethasone in the level of perioperative blood glucose in diabetic patients undergoing surgical procedures under spinal anesthesia is still not well understood. The objective was to examine the effect of administration of 10 mg of dexamethasone on glucose levels in type II diabetic patients compared with nondiabetic in urogynecological, orthopedic and superficial surgery under spinal anesthesia. Fifty-four patients with diabetes and fifty-four nondiabetic were randomized into four groups: Diabetics with dexamethasone (DD), diabetic with saline (DS), nondiabetic with dexamethasone (NDD) and non-diabetic with saline (NDS). Venous blood samples were taken for blood glucose measurements in the laboratory before neuraxial blockade and the administration of 10 mg of dexamethasone and 1, 2, 3 and 4 hours. Glycemias of the five study times were compared in the groups and between them. All groups showed an increase in blood glucose from baseline time for the fourth time, except the DS group, which showed a reduction (-16,09 ± 6,19). Absolute glucose increases over baseline did not differ between diabetic (DD) and nondiabetic (NDD) who received dexamethasone 1, 2, 3 and 4 hours after use. Nondiabetic using dexamethasone (NDD) did not differ from non-diabetics not using dexamethasone (NDS) in all evaluated times as the increase in absolute blood glucose compared to baseline glycemia. The increase in absolute plasma glucose from baseline was statistically greater in the third and fourth hours in diabetics using dexamethasone (DD) (10,58 ± 6,68; 29,71 ± 6,93) when compared to diabetic non using dexamethasone (DS) (-17,26 ± 6,44; -9,16 ± 6,19). Diabetics who did not use dexamethasone (DS) had absolute difference in blood glucose compared to negative baseline (-16,09 ± 6,19) and statistically different from the non-diabetic group who did not use dexamethasone (NDS) (3,96 ± 4,44) in the fourth evaluated time. The hyperglycemic response to the single-dose use of dexamethasone as antiemetic and analgesic in patients undergoing spinal anesthesia for urogenital, orthopedic or superficial surgery, did not differ between diabetic and non-diabetic in the first 4 hours of the procedure. Among the groups of patients who did not use dexamethasone, spinal anesthesia may have favored better glycemic response to endocrine-metabolic surgical stress in diabetic patients compared with nondiabetic.