Decadron and Anesthesia

[GuP]

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49 F with primary brain ca. maintained on decadron 10mg now comes in with b/l broken femurs. Pt. is to undergo b/l ORIF. All labs normal.

As far as decadron goes, what do you with the dosage? Keep it the same or increase it? I tried looking it up but there are no clear cut answers. Some say keep it the same while others say increase it....

 

[Planktonmd]

49 F with primary brain ca. maintained on decadron 10mg now comes in with b/l broken femurs. Pt. is to undergo b/l ORIF. All labs normal.

As far as decadron goes, what do you with the dosage? Keep it the same or increase it? I tried looking it up but there are no clear cut answers. Some say keep it the same while others say increase it....

That 10 mg of Dexamethasone has more than enough Glucocorticoid activity (1mg Dexamethasone = 50-100 mg hydrocortisone glucocorticoid activity) but not enough mineralo corticoid activity to compensate for the suppressed cortisol.
I would keep the same dose of Decadron and you could possibly add Hydrocortisone to compensate for mineralocorticoid activity for a few days but most likely you won't need it.

 

[Noyac]

I believe we will find that we over treat people with steroids in the not to far future. With that being said I agree with Plank. I find that I am holding back more and more with regards to steroids like hydrocortisone but I am pretty liberal with 4mg decadron.

 

[coprolalia]

The anti-inflammatory ratio of decadron to Solu-Cortef is about 30:1 on an equipotent dose. This is, I believe, why we use it so much in anesthesia.

-copro

 

[mille125]

49 F with primary brain ca. maintained on decadron 10mg now comes in with b/l broken femurs. Pt. is to undergo b/l ORIF. All labs normal.

As far as decadron goes, what do you with the dosage? Keep it the same or increase it? I tried looking it up but there are no clear cut answers. Some say keep it the same while others say increase it....

agree with other responses...in this situation I stop decadron and use hydrocortisone.....