British Journal of Anaesthesia 97 (2): 164–70 (2006)

doi:10.1093/bja/ael111 Advance Access publication May 12, 2006

Blood glucose concentration profile after 10 mg

dexamethasone in non-diabetic and type 2 diabetic patients
undergoing abdominal surgery
P. Hans*, A. Vanthuyne, P. Y. Dewandre, J. F. Brichant and V. Bonhomme

University Department of Anaesthesia and Intensive Care Medicine, CHR de la Citadelle,

Liege University Hospital, Belgium
*Corresponding author: University Dpt of Anaesthesia and Intensive Care Medicine, CHR de la Citadelle,
Boulevard du 12eme de Ligne 1, 4000 LIEGE, Belgium. E-mail: pol.hans@chu.ulg.ac.be

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Background. Dexamethasone prevents postoperative nausea and vomiting but may increase
blood glucose. We compared blood glucose concentrations after dexamethasone in non-diabetic
and type 2 diabetic patients undergoing surgery and looked for any association with preoperative
glycosylated haemoglobin [HbA (1c)] and BMI.
Methods. Sixty three patients were enrolled: 32 were non-diabetic (Group ND) and 31 type 2
diabetic (Group D) without insulin treatment. Anaesthesia was induced using i.v. anaesthetic
agents and maintained with sevoflurane. All patients received 10 mg dexamethasone at induction.
Blood glucose concentrations were measured at induction and then every 60 min for 240 min.
Data were analysed using ANOVA. Effects of HbA (1c) and BMI were investigated using linear
correlation and logistic regression.
Results. Blood glucose concentrations increased significantly over time and peaked at 120 min
after 10 mg dexamethasone in both groups. The magnitude of increase was comparable between
the groups [mean (SD) 29 (19) and 35 (19)% of baseline in Group D and Group ND, respectively].
Maximum concentrations were higher in Group D [8.97 (1.51) mmol litre 1, range 6.67–12.94
mmol litre 1] than in Group ND [7.86 (1.00) mmol litre 1, range 5.78–10.00 mmol litre 1]. There
was a significant correlation between the maximum concentrations and BMI (R2=0.21) or HbA
(1c) (R2=0.26). Logistic regression analysis revealed that the higher the BMI, the lower the HbA
(1c) threshold associated with an increased probability (>0.5) of observing blood glucose levels
higher than 8.33 mmol litre 1 during 240 min after dexamethasone administration. Similarly, the
higher the HbA (1c), the lower the BMI threshold associated with the same probability.
Conclusions. After 10 mg dexamethasone, blood glucose levels increase in non-diabetic and
type 2 diabetic patients undergoing abdominal surgery. Poorly controlled diabetes and severe
obesity can influence the development of hyperglycaemia.
Br J Anaesth 2006; 97: 164–70
Keywords: blood, glucose; complications, diabetes; complications, obesity; hormones,
corticosteroid; surgery, postoperative period
Accepted for publication: April 2, 2006

Dexamethasone administered alone or in combination
with other antiemetic drugs has proven efficacious in pre-
venting nausea and vomiting after different types of sur-
gery 1–3 and when morphine is used for patient-controlled
analgesia.4 In addition, it is used in an attempt to decrease
brain oedema, alleviate nerve damage and inhibit the
inflammatory response.5–7 It also reduces pain induced
by administering i.v. propofol.8 However, dexamethasone,
even after single-dose administration, has been shown to
increase blood glucose during surgery.9 This effect may
be related to an increase in neoglucogenesis and the
development of insulin resistance, which have been
demonstrated in both animals and humans.10 11 Hypergly-
caemia is known to be a significant risk factor of adverse
outcome in patients at risk of ischaemia.12–14 Hence, it
may be of interest to determine factors that may influence
blood glucose concentrations during the perioperative
period.

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 Dexamethasone and blood glucose during surgery

Finally, dexamethasone has been reported to increase
blood glucose concentrations in non-diabetic patients9 15
but has not been investigated in diabetics. The aims of
this study were to compare blood glucose concentrations
after a bolus of 10 mg of dexamethasone in non-diabetic
and type 2 diabetic patients undergoing routine surgery, and
to look for any association between increased glycosylated
haemoglobin [HbA (1c)] or BMI and increased blood glu-
cose concentrations in the perioperative period.
Methods
After approval from the regional hospital Ethics Committee
and informed consent, 63 consecutive patients undergoing
early morning elective abdominal surgery were enrolled
subject factor. Post-hoc comparisons were performed using
Tukey’s HSD tests. The same tests were used to compare
blood glucose variations in % of baseline (T0) value. Blood
glucose level expressed as % of baseline was calculated
for each patient using the following formula: Ti%=100·
(BGTi BGT0)/BGT0, where Ti% is blood glucose at time
i expressed in % of baseline, BGTi is absolute blood glucose
value at time i and BGT0 is absolute blood glucose value at
T0. We also used least square linear regression to evaluate
the effect of HbA (1c) and BMI on maximum blood glucose
concentrations measured during the study period in our total
sample of patients, and binary logistic regression to model
the relationship between HbA (1c) and BMI on one hand,
and the probability of observing a blood glucose concentra-
tion higher than 8.33 mmol litre 1 during the 240 min study

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period, on the other hand (SPSS
13.0, SPSS Inc., Chicago,
over a period of 3 months in this prospective open non-
IL, USA). The obtained model allowed calculating, for a
randomized study. They neither received dexamethasone
given BMI value, HbA (1c) threshold above which this
nor insulin before surgery. Thirty-two of them were non-
probability was higher than 0.5, and the same BMI thresh-
diabetic (Group ND). The other 31 patients suffered from
olds for a given HbA (1c) value. The equation of the model
type 2 diabetes mellitus (Group D) which was treated exclu-
served to draw a surface-response curve illustrating the rela-
sively by oral anti-diabetic drugs. These drugs were all
tionship (Matlab
software, version 7.0.1., Mathworks Inc.,
stopped the day before surgery.
Natick, USA). The potential effect of surgical stress was
After a 5 h preoperative fasting, all patients were pre-
investigated by comparing CRP values measured the day
medicated with alprazolam 0.5 mg and atropine 0.5 mg
after surgery between groups of patients, using two-tailed
given orally 1 h before surgery. General anaesthesia was
unpaired t tests. The same test was used to compare maxi-
induced with single doses of sufentanil (0.15 mg kg 1) and
mum observed blood glucose levels. Patient characteristic
propofol (2 mg kg 1) given slowly as bolus injections
data were compared using x2 or two-tailed unpaired t tests.
(propofol approximately 40 mg in 10 s). Tracheal intubation
In all cases, P-values of less than 0.05 were considered
was facilitated with cis-atracurium (0.15 mg kg 1), and
statistically significant. Power calculations were performed
anaesthesia was maintained with sevoflurane vaporized in
using the G-POWER
software.16
nitrous oxide and oxygen ( FIO2 0.5) titrated to achieve stable
haemodynamics. All patients received an i.v. bolus of
10 mg dexamethasone (dexamethasone sodium phosphate,
Organon, Leiden, The Netherlands) at the induction of Results
anaesthesia and 300 mg of clonidine over 15 min at the
Patient characteristics, HbA (1c), BMI and CRP mean val-
beginning of surgery. They did not receive glucose-
ues, and length and type of surgery are presented in Table 1.
containing fluids and blood glucose levels were not
All recruited patients were ASA II. One of the patients,
corrected throughout the study period.
previously not known to be a diabetic, presented with a
Fingerprick capillary blood glucose was measured imme-
HbA (1c) concentration of 6%. The diabetes of this patient
diately before dexamethasone administration (T0) and at 60
was diagnosed during hospitalization. However, in order to
(T1), 120 (T2), 180 (T3) and 240 min (T4) thereafter, using
be consistent with selection criteria of patients, he was con-
an AVL OMNI 9 Modular System (Roche Diagnostics
sidered as belonging to Group ND for the purpose of sta-
Corporation) which was calibrated daily.
tistical analysis.
The day before surgery, blood samples were obtained for
More than 50% of the patients underwent bariatric sur-
measurement of HbA (1c), and BMI was calculated. The C
gery, which can explain high BMI values in both groups.
reactive protein (CRP) was measured the day after surgery
Bariatric surgeries and non-bariatric laparotomies were sig-
in order to determine a possible effect of surgical stress on
nificantly more frequent in Group D than in Group ND.
blood glucose concentrations.
Patients in Group D were significantly older than those in
Group ND. Unsurprisingly, they also had significantly
Statistical analysis higher HbA (1c) [6.0 (0.4) vs 5.4 (0.4) %, respectively]
Data were expressed as mean (SD) unless otherwise stated. and BMI values [40.4 (6.7) vs 34.6 (6.8), respectively],
Normality of distributions was checked when necessary. consistent with their metabolic disorder.
Blood glucose concentrations in the two groups were com- The time course of blood glucose concentrations in
pared using two-way mixed-design ANOVA with patient the two groups is shown in Figure 1. At induction
group as the between subject factor and time as the within of anaesthesia, blood glucose concentration was 7.05

165
 Hans et al.

12
ND D
*
10

Blood glucose (mmol litre–1)

8

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T0 T1 T2 T3 T4
Time after dexamethasone

Fig 1 Blood glucose concentration [mean (SD)] profile in non-diabetic (ND, open squares) and type 2 diabetic (D, closed squares) patients from
induction of anaesthesia (T0) to 60, 120, 180 and 240 min (T1, T2, T3 and T4) after dexamethasone administration. *Blood glucose concentration
significantly higher in Group D than in Group ND throughout the study period and significantly higher at T2 than at all other time points in both
groups.

Table 1 Patient characteristics, HbA (1c), BMI, CRP at day 1, maximum blood increase peaked at T2, amounting to 30 (19) and 25 (20)% of
glucose (MBG) observed (absolute and % of baseline), length of surgery and baseline in Group ND and Group D, respectively. The power
type of surgery in Group ND and Group D. Results of statistical analysis are also
of our design for detecting an interaction between the group
displayed (in that last column, the numbers between parentheses are the degrees
of freedom). *P<0.05 compared with ND group. Data are given as mean (SD) or and the time factors, assuming a difference of 10 units (% of
absolute numbers baseline) between groups during at least three time points, a
ND D Statistics a threshold of 0.05, and a SD of 20 units was 99%. The
maximum increase expressed in % of baseline was 35 (19)%
Patient characteristics in Group ND and 29 (19)% in Group D (Table 1).
N 32 31
Age (yr) 35.9 (22–67) 41.5 (28–59)* t(61)=2.25
When considering the whole sample of patients, the maxi-
Male/female (n) 12/20 12/19 x2(1)= 0.01 mum blood glucose concentration observed for each patient
Other variables was significantly and linearly correlated to BMI (R2=0.21,
HbA (1c) (%) 5.4 (0.4) 6.0 (0.4)* t(61)>100
BMI (kg m 2̇) 34.6 (6.8) 40.4 (6.7)* t(61)=3.4
P<0.01) (Fig. 3A), and HbA (1c) (R2=0.26, P<0.01)
CRP at day 1 (mg dl 1) 5.1 (3.1) 4.5 (2.1) t(61)=0.78 (Fig. 3B). According to binary logistic regression (Fig. 4),
MBG (mmol litre 1) 7.9 (1.0) 9.0 (1.5)* t(61)=3.5 patients whose BMI was, for example, 20 kg m 2 had an
MBG (% of baseline) 35 (19) 29 (19) t(61)=1.47
Length of surgery (min) 114.3 (42.0) 131.7 (41.6) NS
increased risk (>0.5) of presenting blood glucose levels
Surgery higher than 8.33 mmol litre 1 (150 mg dl 1) during the
Bariatric surgery (n) 16 22* 240 min after dexamethasone if their HbA (1c) was higher
Non-bariatric laparoscopy (n) 15 5* x2(2)=7.7 P<0.05
Non-bariatric laparotomy (n) 1 4*
than 8.33%. The same threshold was considerably lower
(5.40%) for a BMI of 40 kg m 2. Similarly, patients
whose HbA (1c) was 5.5% had the same increased risk if
their BMI was higher than 40 kg m 2. The same BMI
(1.14) mmol litre 1 in Group D and 5.84 (0.61) mmol litre 1 threshold was 33 kg m 2 for a HbA (1c) of 6.5%.
in Group ND. Throughout the study period, blood glucose There was no significant difference in mean CRP at day 1
was significantly higher in diabetic than in non-diabetic between Group D and Group ND (Table 1). The power of
patients and peaked at T2, amounting to 8.69 (1.48) detecting a significant difference between the groups was
mmol litre 1 and 7.51 (0.90) mmol litre 1 in Group D 0.97 when considering a a threshold of 0.05, a clinically
and Group ND, respectively. Maximum blood glucose con- relevant difference in mean CRP of 2, a variance of 2 and a
centration measured during the study period was signifi- total number of patients of 63.
cantly higher in Group D [9.0 (1.5) mmol litre 1, range
6.7–12.9 mmol litre 1] than in Group ND [7.9 (1.0)
mmol litre 1, range 5.8–10.0 mmol litre 1] (Table 1).
Regarding blood glucose concentrations expressed as % Discussion
of baseline (Fig. 2), we did not observe any significant The main finding of this study is that over a 240 min period
difference between Group D and Group ND. The relative after a bolus of 10 mg dexamethasone given at induction of

166
 Dexamethasone and blood glucose during surgery
60
50
Blood glucose (% of baseline)
40
30
20
10
ND
D
0
T1
Time after dexamethasone
Fig 2 Blood glucose concentration expressed as % of baseline [mean (SD)] in non-diabetic (ND, open squares) and type 2 diabetic (D, closed
squares) patients from T1 to T4. The way of calculating % of baseline can be found in the text. *Blood glucose concentration in % of baseline
significantly higher at T2 than at T1, T3 and T4 in both groups. +Blood glucose concentration significantly higher at T3 than at T4 in both groups.
anaesthesia, blood glucose concentrations remain signifi-
cantly higher in type 2 diabetic than in non-diabetic patients
undergoing routine abdominal surgery. Blood glucose con-
centrations peaked 120 min after dexamethasone in both
groups. The magnitude of increase (as % increase from
the baseline) was not different between the diabetic and
the non-diabetic patients.
Dexamethasone has already been reported to produce
significantly larger increases in blood glucose concentra-
tions in non-diabetic patients undergoing elective cran-
iotomy.9 15 Patients not taking dexamethasone before
surgery but receiving it during and after operation have
been reported to have a greater increase in blood glucose
concentrations from preinduction values than patients who
did not receive dexamethasone or those normally on dexa-
methasone and who also received it during operation.15
However, this is the first study to demonstrate that the profile
of blood glucose levels, although parallel, is significantly
higher in diabetic than in non-diabetic patients after 10 mg
of dexamethasone given as single dose. This dose may seem
to be high in the context of routine abdominal surgery and
prevention of postoperative nausea and vomiting, as
opposed to doses used for prevention and treatment of
brain oedema. However, several studies investigating the
antiemetic effect of dexamethasone used at least 8 mg,1 2
and Lee and colleagues4 have reported higher satisfaction
rates in patients receiving between 8 and 12 mg. This is the
reason why we chose 10 mg dose in this study.
In our study, we also investigated the effect of HbA (1c)
and BMI on blood glucose concentrations. In any individual,
HbA (1c) is known to reflect blood glucose values over the
two previous months. Hence, it reflects the efficacy of treat-
ment in diabetic patients. A significant linear correlation
*
+
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T2 T3 T4
was observed between HbA (1c) and maximum blood glu-
cose concentrations: the higher the HbA (1c), the higher the
blood glucose concentration. Maximum glucose concentra-
tion was also linearly correlated with BMI. Therefore, obes-
ity and poor control of diabetes appear to be determinant
factors of hyperglycaemic response to surgery after dexa-
methasone administration.
The maximum blood glucose concentrations measured
in this study were not excessively high (highest value:
12.9 mmol litre 1 or 232.2 mg dl 1) and were of debatable
clinical significance. However, it is worth noting that poor
control of intraoperative blood glucose concentration with
values higher than 7.78 mmol litre 1 (140 mg dl 1) may be
associated with a worsened outcome in cardiac surgery
patients.14 In stroke patients, a level of 10 mmol litre 1
has been reported as the threshold for definitive intervention
to prevent secondary brain damage.17 18 Hence, checking for
normality of glycaemia during surgery and knowing about
factors that can affect blood glucose profile may be impor-
tant, at least in the patients described above. A blood glucose
concentration slightly higher than normal should have no
consequence in the majority of surgical patients, but even
moderate hyperglycaemia may have disastrous conse-
quences when associated with ischaemia. The logistic
regression model described here allows determining the
risk of a given patient for attaining such blood glucose
levels, as a function of his/her BMI and HbA (1c) values.
For example, a type 2 diabetic patient with a low BMI of
20 kg m 2 will be at an increased risk if his/her HbA (1c) is
8.33% or higher, indicating a poorly controlled diabetes.
Similarly, a non-diabetic patient will be at increased risk
if his/her BMI is very high (i.e. in the range of 40 kg m 2).
However, it must be kept in mind that this may only have
167
 Hans et al.

A 14

12

Max blood glucose (mmol litre–1)

10

2 y =0.087x +5.1525
R 2=0.2093

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0
20 25 30 35 40 45 50 55
BMI

B 14

12
Max blood glucose (mmol litre–1)

10

2 y =1.3731x+0.6294
R 2=0.2355

0
4 4.5 5 5.5 6 6.5 7 7.5 8
HbA (1c) (%)

Fig 3 Least square linear regression between maximum blood glucose concentration observed during the study period and BMI (A) or HbA (1c) (B).
The equation of the regression line is given, and the squared correlation coefficient.

clinical consequences in patients submitted to major surgery
and that blood glucose levels can be corrected during the
course of surgery.
The lack of randomization in this study deserves com-
ments. The main purpose of our study was to compare blood
glucose profiles in diabetic and non-diabetic patients having
received dexamethasone. This was done in a prospective
non-randomized manner. Although length of surgery and
protocol of anaesthesia were similar in both groups, post-
hoc selection of patients based on their diabetic status has
artificially biased repartition of types of surgeries. Blood
glucose concentration has previously been shown to
increase significantly over the course of surgery in patients
who do not receive dexamethasone.9 Such an increase could
be attributed to the stress response characterized by changes
in serum norepinephrine, epinephrine and cortisol levels.19
It is therefore possible that the degree of surgical stimulus
could have biased the results of this study. However, CRP is
considered a reliable index to quantify the magnitude of
surgical trauma and patient’s inflammatory response to sur-
gery.20 In our study, there were no differences between
groups in CRP measured at day 1 and the power of detecting
a clinically relevant difference was high. We can therefore
assert with reasonable confidence that the degree of surgical
stimulus was comparable between our two groups of
patients.
Another potential confounding factor is the use of cloni-
dine. Our patients all received a fixed amount of 300 mg. As
clonidine is known to affect glycaemic response to surgery21
and as BMI was significantly higher in Group D than in

168
 Dexamethasone and blood glucose during surgery

Probability of blood glucose >8.33 mmol litre–1

0.9

0.8

0.7

0.6

0.5

0.4

0.3

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0.2

0.1 8

6
60 50 40 30 20
BMI (kg m–2) HbA (1c) (%)

Fig 4 Binary logistic regression between BMI (kg m 2) and HbA (1c) (%) on one hand, and the probability of observing a blood glucose level
higher than 8.33 mmol litre 1 during 240 min after dexamethasone administration, on the other hand. The equation provided by the analysis is
logit(P)=0.137 BMI+0.936 HbA (1c) 10.538, where logit(P)=ln [P/(1 P)] and P=probability of observing a blood glucose concentration higher
than 8.33 mmol litre 1. Nagelkerke pseudo R2=0.306, Hosmer and Lemeshow x 2(8)=7.485, P=0.485. The isocurve of the 50% probability of
observing a blood glucose level higher than 8.33 mmol litre 1 is shown by the thick straight line. Circles correspond to individual recordings of
BMI and HbA (1c) in non-diabetic (open) and type 2 diabetic (closed) patients plotted against the probability calculated according to the logistic
regression model.

Group ND, one could wonder to what extent clonidine dif- preoperative HbA (1c) were determinant factors of periop-
ferently affected blood glucose in the two groups of patients. erative blood glucose concentration. Paying attention to
Indeed, clonidine attenuates stress-induced blood glucose these factors is important to detect patients at higher risk
elevations through its blocking effects on the adrenergic of experiencing elevated blood glucose levels that are
response to surgery. This effect occurs at doses higher known to be associated with worsened outcomes after
than 2 mg kg 1, such as in our study. Given at lower major surgery or in patients at risk of ischaemia. After
doses (1 mg kg 1), clonidine inhibits b cells of the pancreas dexamethasone administration, tight monitoring of blood
and limits insulin secretion, which can accentuate the hyper- glucose and correction of hyperglycaemia in those patients
glycaemic response induced by surgery. As the opposite should be recommended.
effects of clonidine on blood glucose are dose-related,
and as the dose of clonidine administered to our patients
was higher than 2 mg kg 1, the risk that clonidine could have References
affected blood glucose in opposite directions in the two 1 Panda NB, Bharadwaj N, Kapoor P, Chari P, Panda NK. Preven-
groups is low. We cannot exclude the possibility that the tion of nausea and vomiting after middle ear surgery: combination
of ondansetron and dexamethasone is the right choice.
limitation of blood glucose increase by clonidine was lower
J Otolaryngol 2004; 33: 88–92
in our diabetic group of patients, as they had higher body 2 Fujii Y, Numazaki M. Randomized, double-blind comparison of
weights and received the same dose of clonidine as non- subhypnotic-dose propofol alone and combined with dexametha-
diabetic patients. However, it remains that we observed a sone for emesis in parturients undergoing cesarean delivery.
good correlation between blood glucose increase and HbA Clin Ther 2004; 26: 1286–91
(1c), a variable that can be considered as independent to the 3 Madan R, Bhatia A, Chakithandy S, et al. Prophylactic dexametha-
dose of clonidine. sone for postoperative nausea and vomiting in pediatric strabis-
mus surgery: a dose ranging and safety evaluation study. Anesth
In conclusion, we found that, after a bolus of 10 mg
Analg 2005; 100: 1622–6
dexamethasone, blood glucose concentration profile, 4 Lee Y, Lai HY, Lin PC, Lin YS, Huang SJ, Shyr MH. A dose ranging
although parallel, was significantly higher in type 2 diabetic study of dexamethasone for preventing patient-controlled
than in non-diabetic patients undergoing routine abdominal analgesia-related nausea and vomiting: a comparison of droperidol
surgery and peaked 120 min after injection. BMI and with saline. Anesth Analg 2004; 98: 1066–71

169
 Hans et al.
5 Kaal EC, Vecht CJ. The management of brain edema in brain
tumors. Curr Opin Oncol 2004; 16: 593–600
6 Lundin A, Magnuson A, Axelsson K, Nilsson O, Samuelsson L.
Corticosteroids perioperatively diminishes damage to the
C-fibers in microscopic lumbar disc surgery. Spine 2005; 30:
2362–7
7 Jamieson NB, Glen P, McMillan DC, et al. Systemic inflammatory
response predicts outcome in patients undergoing resection for
ductal adenocarcinoma head of pancreas. Br J Cancer 2005; 92:
21–3
8 Singh M, Mohta M, Sethi AK, Tyagi A. Efficacy of dexamethasone
pretreatment for alleviation of propofol injection pain. Eur J Anaes-
thesiol 2005; 22: 888–90
9 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
10 Matsumoto K, Yamasaki H, Akazawa S, et al. High-dose but not
low-dose dexamethasone impairs glucose tolerance by inducing
compensatory failure of pancreatic beta-cells in normal men. J Clin
Endocrinol Metab 1996; 81: 2621–6
11 Rhee MS, Perianayagam A, Chen P, Youn JH, McDonough AA.
Dexamethasone treatment causes resistance to insulin-
stimulated cellular potassium uptake in the rat. Am J Cell Physiol
2004; 287: C1229–37
12 Juvela S, Siironen J, Kuhmonen J. Hyperglycemia, excess weight,
and history of hypertension as risk factors for poor outcome and
cerebral infarction after aneurysmal subarachnoid hemorrhage.
J Neurosurg 2005; 102: 998–1003
170
13 Doenst T, Wijeysundera D, Karkouti K, et al. Hyperglycemia
during cardiopulmonary bypass is an independent risk factor
for mortality in patients undergoing cardiac surgery. J Thoracic
Cardiovasc Surg 2005; 130: 1144
14 Ouattara A, Lecomte P, Le Manach Y, et al. Poor intraoperative
blood glucose control is associated with a worsened hospital
outcome after cardiac surgery in diabetic patients. Anesthesiology
2005; 103: 687–94
15 Lukins MB, Manninen PH. Hyperglycemia in patients administered
dexamethasone for craniotomy. Anesth Analg 2005; 100: 1129–33
16 Faul F, Erdfelder E. GPOWER: A priori, post-hoc, and compromise
power analyses for MS-DOS [Computer program]. Bonn, FRG:
Bonn University, Department of Psychology, 1992. Available from
http://www.psychologie.uni-trier.de:8000/projects/gpower
17 Garg R, Chaudhuri A, Munschauer F, Dandona P. Hyperglycemia,
insulin, and acute ischemic stroke: a mechanistic justification for a
trial of insulin infusion therapy. Stroke 2006; 37: 267–73
Downloaded from https://academic.oup.com/bja/article/97/2/164/397513 by guest on 18 June 2023
18 Lees KR, Walters MR. Acute stroke and diabetes. Cerebrovasc Dis
2005; 20 (Suppl. 1): 9–14
19 Stene JK, Vary TC. Nutritional aspects. In: Miller R, ed. Anesthesia,
5th Edn. Philadelphia: Churchill Livingstone, 2000; 2504–5
20 Morariu AM, Loef BG, Aarts LP, et al. Dexamethasone: benefit,
prejudice for patients undergoing on-pump coronary artery
bypass grafting: a study on myocardial, pulmonary, renal, intesti-
nal, and hepatic injury. Chest 2005; 128: 2677–87
21 Lattermann R, Schricker T, Georgieff M, Schreiber M. Low dose
clonidine premedication accentuates the hyperglycemic response
to surgery. Can J Anaesth 2001; 48: 755–9