Postoperative glycemic control in head and neck surgery

Background & aims

This study aimed to investigate the consequences of pre-operative dexamethasone administered to prevent post-operative pain and nausea on post-operative glycemic control and its influence on recovery.

Methods

A randomized controlled trial was conducted with hospitalized head and neck surgery patients receiving glucocorticoid premedication. Participants were randomized into intervention and control groups, and blood glucose was continuously monitored using the Freestyle Libre system. For hyperglycemia, insulin was administered per protocol in the intervention group but not in the control group. Secondary outcomes included muscle function, hydration, and recovery assessments.

Results

In 26 patients (21 % dropout rate), hyperglycemia (blood glucose (BG) ≥10 mmol/L) was observed in 54 % of patients. BG was correlated with age and duration of surgery, but normalized by small doses of rapid-acting insulin. Elevated p-C-peptide levels were associated with hyperglycemia. No significant differences between groups were found in maximum blood glucose, hospital stay, or readmissions. The intervention group showed significant muscle loss and poorer swallowing function but maintained functional ability in sit-to-stand tests.

Conclusions

Postoperative hyperglycemia was common during head and neck surgery, but was normalized by small doses of insulin despite the indications of postoperative insulin resistance. The intervention was never activated, as the problems with postoperative insulin resistance were minor and less than expected despite the administration of preoperative dexamethasone. Accordingly, standard protocols do not seem indicated in the postoperative care of these patients, but frequent measurements of blood glucose are recommended.

Clinical Trials registration

NCT04021186.