Intravenous dexamethasone administration during anesthesia induction can improve postoperative nutritional tolerance of patients following elective gastrointestinal surgery: A post-hoc analysis

Feng Tian; Xinxiu Zhou; Junke Wang; Mingfei Wang; Zhou Shang; Leping Li; Changqing Jing; Yuezhi Chen

doi:10.3389/fnut.2023.1093662

Intravenous dexamethasone administration during anesthesia induction can improve postoperative nutritional tolerance of patients following elective gastrointestinal surgery: A post-hoc analysis

Front Nutr. 2023 Mar 2:10:1093662. doi: 10.3389/fnut.2023.1093662. eCollection 2023.

Authors

Feng Tian^{1

2}, Xinxiu Zhou¹, Junke Wang¹, Mingfei Wang², Zhou Shang¹, Leping Li^{1

2}, Changqing Jing^{1

2}, Yuezhi Chen^{1

2}

Affiliations

¹ Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
² Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.

Abstract

Aim: To investigate the effect of intravenous dexamethasone administration on postoperative enteral nutrition tolerance in patients following gastrointestinal surgery.

Methods: Based on the previous results of a randomized controlled study to explore whether intravenous administration of dexamethasone recovered gastrointestinal function after gastrointestinal surgery, we used the existing research data from 1 to 5 days post operation in patients with enteral nutrition tolerance and nutrition-related analyses of the changes in serum indices, and further analyzed the factors affecting resistance to enteral nutrition.

Result: The average daily enteral caloric intake was significantly higher in patients receiving intravenous administration of dexamethasone during anesthesia induction than in controls (8.80 ± 0.92 kcal/kg/d vs. 8.23 ± 1.13 kcal/kg/d, P = 0.002). Additionally, intravenous administration of 8 mg dexamethasone during anesthesia induction can reduce the changes in postoperative day (POD) 3, POD5, and preoperative values of serological indices, including ΔPA, ΔALB, and ΔRBP (P < 0.05). In the subgroup analysis, dexamethasone significantly increased the average daily enteral nutrition caloric intake in patients undergoing enterotomy (8.98 ± 0.87 vs. 8.37 ± 1.17 kcal/kg/d, P = 0.010) or in female patients (8.94 ± 0.98 vs. 8.10 ± 1.24 kcal/kg/d, P = 0.019). The changes of serological indexes (ΔPA, ΔALB, and ΔRBP) in the dexamethasone group were also significantly different on POD3 and POD5 (P < 0.05). In addition, multivariate analysis showed that dexamethasone use, surgical site, and age might influence enteral nutrition caloric tolerance.

Conclusion: Postoperative enteral nutrition tolerance was significantly improved in patients receiving intravenous administration of dexamethasone during anesthesia induction, especially in patients following enterotomy surgery, with significant improvements in average daily enteral caloric intake, PA levels, ALB levels, and RBP levels.

Clinical trial registration: http://www.chictr.org.cn, identifier: ChiCTR1900024000.

Keywords: dexamethasone; enteral nutrition; gastrointestinal cancer; gastrointestinal surgery; nutritional indicators.

Grants and funding

This research was funded by the National Natural Science Foundation of China under Grant [81900524], the Natural Science Foundation of Shandong Province under Grants [ZR2020MH252, ZR2020MH205, and ZR2022MH085], the China Postdoctoral Science Foundation under Grant [2020M672102], and the Science and Technology Development Program of Jinan under Grant [202134027].