gms | German Medical Science

Objective: The aim of this study is to evaluate the impact of pre- and intraoperative steroid administration on the metabolic recompensation in the early postoperative intensive care unit phase of patients undergoing neurosurgical removal of intracranial tumors, such as gliomas and meningiomas.

Methods: In total, we included 674 patients which underwent neurosurgical resection and were followed up on ICU. Tumor histology included glioblastoma (IDHwt, n = 284), astrocytoma (IDHmut, n = 184), 142 oligodendroglioma (n = 142), and meningioma (n = 100). Basic parameters, such as gender, age, pre- and perioperative dexamethasone administration, tumor location, Ki67 index, WHO grade, surgery lengths, as well as 17 postoperative metabolic and basic blood parameters recorded while in intensive care were analyze using a LMER and a linear statistic approach. Patients were subsequentially stratified into high (>4mg) and low (<4mg) cumulative dexamethasone application pre- and intraoperatively. This retrospective study of anonymized data sets was performed in concordance with the local ethic guidelines.

Results: Multivariate analysis showed that patients receiving high doses of dexamethasone displayed strong metabolic alterations, as they had a significantly higher pH, with increased base excess and HCO3 levels, accompanied by a steadily increased lactate level (all p<0.001), never reaching the same level in the early postoperative phase (24h) on ICU. In addition, systolic and diastolic blood pressure levels (p<0.01) were significantly increased in the high dexamethasone group. As expected, increased blood pressure levels inversely correlated with a reduced heart frequency, which was on average 10bpm lower throughout the whole ICU stay in the high dexamethasone group. After the first 10h on the ICU, patients receiving high dose dexamethasone displayed a reduced body core temperature (mean reduction -0.3°C, p<0.001). The effect on the glucose metabolism was significant in the early phase (hours 0-5), and increased after 20h ICU stay, showing significant glucose derangements (>200mg/dl; p<0.05). No differences were found between different tumor entities.

Conclusion: We found that pre- and intraoperatively administration of high doses of dexamethasone had significant impact on the metabolic recompensation of neurooncological patients undergoing neurosurgical resection and may have to be used more cautiously in the future.