Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

Direkt zur Navigaton springen.
Direkt zum Inhalt springen.

Navigation/Suche

Gewählte Publikation:

SHR Neuro Krebs Kardio Lipid Stoffw Microb

Abdelmalak, BB; Bonilla, A; Mascha, EJ; Maheshwari, A; Tang, WHW; You, J; Ramachandran, M; Kirkova, Y; Clair, D; Walsh, RM; Kurz, A; Sessler, DI.
Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial
BRIT J ANAESTH. 2013; 111(2): 209-221. Doi: 10.1093/bja/aet050
Web of Science PubMed FullText FullText_MUG

Co-Autor*innen der Med Uni Graz: Kurz Andrea
Altmetrics:
Dimensions Citations:
Plum Analytics:
Scite (citation analytics):
Abstract:: The inflammatory response to surgical tissue injury is associated with perioperative morbidity and mortality. We tested the primary hypotheses that major perioperative morbidity is reduced by three potential anti-inflammatory interventions: (i) low-dose dexamethasone, (ii) intensive intraoperative glucose control, and (iii) lighter anaesthesia. We enrolled patients having major non-cardiac surgery who were 40 yr old and had an ASA physical status IV. In a three-way factorial design, patients were randomized to perioperative i.v. dexamethasone (a total of 14 mg tapered over 3 days) vs placebo, intensive vs conventional glucose control 80110 vs 180200 mg dl(1), and lighter vs deeper anaesthesia (bispectral index target of 55 vs 35). The primary outcome was a collapsed composite of 15 major complications and 30 day mortality. Plasma high-sensitivity (hs) C-reactive protein (CRP) concentration was measured before operation and on the first and second postoperative days. The overall incidence of the primary outcome was about 20. The trial was stopped after the second interim analysis with 381 patients, at which all three interventions crossed the futility boundary for the primary outcome. No three-way (P0.70) or two-way (all P0.52) interactions among the interventions were found. There was a significantly smaller increase in hsCRP in patients given dexamethasone than placebo [maximum 108 (64) vs 155 (69) mg litre(1), P0.001], but none of the other two interventions differentially influenced the hsCRP response to surgery. Among our three interventions, dexamethasone alone reduced inflammation. However, no intervention reduced the risk of major morbidity or 1 yr mortality.
Find related publications in this database (Keywords): depth of anaesthesia; glucose control; hsCRP; perioperative inflammation; steroid