Monitoring Blood Glucose as a Perioperative Stress Response Marker and the Effect of Dexmedetomidine Premedication in Laparoscopic Surgery Patients: A Randomised Controlled Study

Abstract

Introduction: Perioperative stress increases cortisol levels, which in turn elevates glucose production. Thus, regular monitoring of glucose during the perioperative period can predict intraoperative stress and the depth of anaesthesia. Dexmedetomidine (Dex) is used as an adjunct during anaesthesia to attenuate the pressor response during tracheal intubation. Aim: To assess sequential blood sugar values in Dex-mediated attenuation of the perioperative neuroendocrine stress response. Materials and Methods: A randomised, controlled, double-blinded study was conducted at the Department of Anaesthesiology, M.K.C.G Medical College and Hospital, Berhampur, Odisha, India on 80 patients undergoing laparoscopic surgery, divided into two groups (n=40). Group-I was administered 50 mL of Normal saline i.v. over 10 minutes, whereas Group-II received Dex 1 mcg/kg in 0.9% normal saline diluted to 50 mL over 10 minutes i.v.. Blood glucose levels and haemodynamic parameters such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Heart Rate (HR) were evaluated in the preoperative room, 30 minutes after surgical incision, after extubation, one hour after surgery, and 2.5 hours following surgery. Unpaired Student’s t-test was used to compare the variables at different time points. Results: There was no significant difference in age (48.58±5.89 and 46.25±6.51 years; p>0.05), weight (57.07±7.84 and 56.8±7.4 kg; p>0.05), and American Society of Anaesthesiologists (ASA) status among the Group-I and Group-II patients. Female preponderance was observed, but it was not significant between Group-I and Group-II patients (27 vs 31; p>0.05). In Group-II, Dex-administered patients, the mean blood sugar levels at 30 minutes past surgical incision, after extubation, one hour, and 2.5 hours following surgery were 104.35±13.58, 97.15±5.86, 98.4±7.45, 94.08±7.37 mg/dL, respectively. This was lower when compared to Group-I saline-treated patients, 135.95±14.4, 137.38±7.93, 138.08±8.84, and 137.70±15.13 mg/dL, and was found to be significant (p<0.05). Conclusion: Serial blood glucose estimation can be a useful marker to evaluate the perioperative neuroendocrine response. Dex premedication has effectively modulated the neuroendocrine stress response during anaesthesia.

Keywords

• cortisol
• mean arterial pressure
• saline