Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial

Area of Science:

• Perioperative Medicine
• Surgical Inflammation
• Clinical Trials

Background:

• Surgical tissue injury triggers an inflammatory response, contributing to perioperative complications.
• Investigating interventions to mitigate this inflammatory response is crucial for improving patient outcomes.
• Three interventions were evaluated: low-dose dexamethasone, intensive intraoperative glucose control, and lighter anesthesia.

Purpose of the Study:

• To determine if low-dose dexamethasone, intensive glucose control, or lighter anesthesia reduce major perioperative morbidity and mortality.
• To assess the impact of these interventions on the inflammatory marker high-sensitivity C-reactive protein (hsCRP).

Main Methods:

• A three-way factorial randomized controlled trial involving patients undergoing major non-cardiac surgery.
• Patients received perioperative intravenous dexamethasone or placebo, intensive or conventional glucose control, and lighter or deeper anesthesia.
• The primary outcome was a composite of major complications and 30-day mortality; hsCRP levels were monitored.

Main Results:

• The overall incidence of the primary outcome was approximately 20%.
• Dexamethasone significantly reduced the increase in hsCRP compared to placebo, indicating an anti-inflammatory effect.
• None of the three interventions demonstrated a significant reduction in major morbidity or 30-day mortality.

Conclusions:

• Low-dose dexamethasone effectively reduced perioperative inflammation as measured by hsCRP.
• Despite reducing inflammation, dexamethasone, intensive glucose control, and lighter anesthesia did not decrease major morbidity or mortality.
• Further research may be needed to identify effective strategies for reducing perioperative complications.