Laparoskopik kolesistektomide peroperatif uygulanan steroidin diyabetik ve diyabetik olmayan hastaların kan şekeri üzerine etkileri

Yıl 2018, Cilt: 2 Sayı: 3, 249 - 252, 01.09.2018

Duygu Demiriz Gülmez Asu Özger Özgültekin Osman Ekinci Mehmet Gülmez

https://doi.org/10.28982/josam.424450

Öz

Amaç: Genel anestezi altında laparoskopik kolesistektomi yapılan diyabetik ve diyabetik olmayan hastalara postoperatif dönemde oluşabilecek komplikasyonları önlemek amacıyla uygulanan 8 mg deksametazonun kan şekeri üzerine etkilerini gözlemlemek.

Yöntemler: Laparoskopik kolesitektomi planlanan, çalışmaya katılma kriterlerini karşılayan 100 hasta, 50 diyabetik olmayan ve 50 diyabetik hasta olmak üzere iki gruba ayrıldı. 8 mg deksametazon uygulanmasından sonra 30. ve 120. dk kan şekeri değerleri ölçüldü ve gruplar arasında karşılaştırıldı.

Bulgular: Diyabetik olmayan grupta kan şekerindeki 30. ve 120. dk değerlerindeki artış indüksiyon öncesi kan şekeri değerlerine göre istatistiksel olarak anlamlı idi (p=0.002 ve p=0.000). Kan şekeri seviyelerinin 30. ve 120. dk değerleri karşılaştırıldığında, zaman ilerledikçe istatistiksel olarak anlamlı bir artış olduğu tespit edildi (p=0.000).

Sonuç: Çalışmamızın sonuçlarına göre deksametazon diyabetik ve diyabetik olmayan hastalarda cerrahiden 12 saat sonra hiperglisemiye yol açmaktadır. Bu sebeple deksametazon uygulanmasından sonra kan şekerinin sıkı bir şekilde izlenmesi gerektiğini önermekteyiz.

Anahtar Kelimeler

Kan şekeri, Diyabet, Steroid

Effects of peri-operative administration of steroids on the blood glucose levels of patients with and without diabetes undergoing laparoscopic cholecystectomy

Öz

Aim: To examine blood glucose levels in patients with and without diabetes undergoing laparoscopic cholecystectomy under general anesthesia following intravenous administration of 8 mg dexamethasone to minimize postoperative complications.

Methods: Hundred patients, 50 patients with diabetes and 50 without diabetes, who underwent laparoscopic cholecystectomy and met the inclusion criteria, were divided into 2 groups. After administration of 8 mg dexamethasone, blood glucose values were observed at the 30th and 120th min and compared between the groups.

Results: Increase in blood glucose levels at the 30- and 120-min marks were statistically significant relative to the pre-induction blood glucose levels (p=0.002 and p=0.000, respectively) in the non-diabetic group. On comparing blood glucose levels at the 30- and 120-min marks, a statistically significant increase was seen to have occurred over time (p=0.000).

Conclusion: Results of the current study showed that dexamethasone caused hyperglycemia in patients with and without diabetes the 12 h after surgery. We recommend that after administration of dexamethasone, tight monitoring of blood glucose levels should be considered.

Anahtar Kelimeler

Blood Glucose, Diabetes, Steroid

Kaynakça

• 1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047-53.
• 2. Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, et al. Population-based study of diabetes and risk characteristics in turkey results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care. 2002;25:1551-6.
• 3. Smiley DD, Umpierrez GE. Perioperative glucose control in the diabetic or nondiabetic patient. South Med J. 2006;99:580.
• 4. Juul AB, Wetterslev J, Kofoed-Enevoldsen A. Long-term postoperative mortality in diabetic patients undergoing major non-cardiac surgery. Eur J Anaesthesiol. 2004;21:523-9.
• 5. Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American association of clinical endocrinologists and American diabetes association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15:353-69.
• 6. Robertshaw HJ, McAnulty GR, Hall GM. Strategies for managing the diabetic patient. Best Pract Res Clin Anaesthesiol. 2004;18:631-43.
• 7. Latham R, Lancaster AD, Covington JF, Pirolo JS, Thomas CS. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control. 2001;22:607-12.
• 8. Ramos M, Khalpey Z, Lipsitz S, Steinberg J, Panizales MT, Zinner M, et al. Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg. 2008;248:585-91.
• 9. Moitra VK, Meiler SE. The diabetic surgical patient. Curr Opin Anaesthesiol. 2006;19:339-45.
• 10. Ljungqvist O, Nygren J, Soop M, Thorell A. Metabolic perioperative management: novel concepts. Curr Opin Crit Care. 2005;11:295-9.
• 11. Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care. 1999;2:69-78.
• 12. Hans P, Vanthuyne A, Dewandre PY, Brichant JF, Bonhomme V. Blood glucose concentration profile after 10 mg dexamethasone in non-diabetic and type 2 diabetic patients undergoing abdominal surgery. Br J Anaesth. 2006;97:164-70.
• 13. Abdelmalak BB, Bonilla AM, Yang D, Chowdary HT, Gottlieb A, Lyden SP, et al. The hyperglycemic response to major noncardiac surgery and the added effect of steroid administration in patients with and without diabetes. Anesth Analg. 2013;116:1116-22.
• 14. Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg. 2000;195:186-712.
• 15. Weber CR, Griffin JM. Evaluation of dexamethasone for reducing postoperative edema and inflammatory response after orthognathic surgery. J Oral Maxillofac Surg. 1994;52:35-9.
• 16. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial. Ann Surg. 2003;238:651-60.
• 17. Ljungqvist O, Nygren J, Soop M, Thorell A. Metabolic perioperative management: novel concepts. Curr Opin Crit Care. 2005;11:295-9.
• 18. Lukins MB, Manninen PH. Hyperglycemia in patients administered dexamethasone for craniotomy. Anesth Analg. 2005;100:1129-33.
• 19. Pasternak JJ, McGregor DG, Lanier WL. Effect of single-dose dexamethasone on blood glucose concentration in patients undergoing craniotomy. J Neurosurg Anesthesiol. 2004;16:122-5.