Preop stress steroid

[waterbottle10]

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I often see recommendations from patients primary specialists for preop stress steroids if the patient is chronic steroids before surgery. However they always recommend hydrocortisone and on our Anes exams the answer is also hydrocortisone. Since we already often give dexmethasaone for nausea and pain , why not just Dex??

 

[Shimmy8]

search the forum. Been discussed at length previously, recent guidelines, etc.

 

[waterbottle10]

Thank you. I guess it's a common question. I guess I will continue giving Dex .1mg/kg

 

[pgg]

All you'll ever need to know about dexamethasone vs hydrocortisone with regard to "stress dose steroids" ...

http://pggweb.com/doc/glucocorticoids.pdf

In particular

As explained earlier, patients with glucocorticoid-induced secondary adrenal insufficiency do not have mineralocorticoid (aldosterone) deficiency. The mineralocorticoid activity of hydrocortisone may produce undesirable side effects including fluid retention, edema, and hypokalemia. Thus, it is preferable to use a glucocorticoid without mineralocorticoid activity when treating patients with this condition, especially when the total dose of hydrocortisone exceeds 100 mg per day.

...

Hypotension in patients previously treated with glucocorticoids is caused by loss of the permissive effect of glucocorticoids on vascular tone, which may be related in turn to enhanced PGI2 production in the absence of glucocorticoids. It is not caused by mineralocorticoid deficiency.

IMO dexamethasone is the better choice.

 

[facted]

Good review article in Anesthesiology recently:
Perioperative Steroid Management: Approaches Based on Current Evidence. - PubMed - NCBI

 

[hankbb02]

All you'll ever need to know about dexamethasone vs hydrocortisone with regard to "stress dose steroids" ...

http://pggweb.com/doc/glucocorticoids.pdf

In particular

IMO dexamethasone is the better choice.

Thanks PGG. I have always wondered if a standard 4mg dose of dexamethasone for PONV prophylaxis was sufficient to prevent secondary adrenal insufficiency. Based on that article, you could argue that it is.