Surgery next week

[Daylily2000]

I’m scheduled for laparoscopic hysterectomy Wed. the 20th. I had my pre-op yesterday and spoke to the anesthesiologist. I asked him if I would be given extra steroids during the procedure and his answer was no! Because it is not indicated if your daily dose is 10mg or less. Comments/suggestions?

[PMRpro Ambassador]

Strange argumentation, the adrenal function remains compromised even at doses below 10mg if you have been on pred for a long time. Perhaps they prefer close monitoring post-op.

It used to be standard practice to give a few days of high dose steroids pre and peri-operatively but the opinion changed when it was shown that even withdrawing steroids for several days did not result in adrenal crises. There was concern about overloading the patient with steroids and the resultant side effects (where have we heard that before?). Current guidelines include this:

"Patients at low risk of HPAA suppression, including patients who have been treated with any dose of glucocorticoid for less than 3 weeks, morning doses of prednisone 5 mg/day or less, or prednisone 10 mg/day every other day. Perioperative stress-dose steroids are not required unless they exhibit signs of HPAA suppression."

I wonder if someone has misunderstood the "prednisone 10 mg/day every other day"? According to the quote which is from this article aimed at anaesthetists

anesthesiology.pubs.asahq.o...

you WOULD qualify for something but I'm not sure if it would be just more intense monitoring since you take more than 5mg in the morning daily.

[Daylily2000 in reply to PMRpro]

Thanks. I believe he did say I would be monitored.

[scats]

They said the same at my hip replacement. I was at 10mg so no extra needed. Was OK at the time, big flare later probably because I couldn't rest it as I should have.

[Christophene47]

Hi Daylily, First good luck with your upcoming surgery. I am in the US and from everything I've read, many doctors here think that when the body is to undergo a stressful situation such as surgery, it is advisable to up the dose the day before or night before. I did not raise the subject , he did.

I had to have a biopsy of my lip done, and the oral surgeon asked me to take my original highest dose the night before and that morning because he didn't want any unanticipated inflammation. I did take my original highest dose of 16mg and all went smoothly. That was under local anesthesia.

Will you be having general anesthesia? Will you have an open incision, or a laparoscopy?

I don't see what 10 mg. has to do with being a guideline.

The point is physical and emotional stress of of any kind is the standard to justify a temporary increase. Maybe you could slip in a word with your surgeon and consultant in advance.

Hope all goes well. Keep us posted,

[Daylily2000 in reply to Christophene47]

Thanks! I’ve decided to increase my dosage before and after the surgery at home!

[Christophene47]

I should have said that I didn't raise the subject with surgeon about upping my dose; he did and asked me to do it. PMR Pro knows the exact info in the U.K., but here in USA ,it is more a question of judgement of the doctor and what the patient feels comfortable with.

[PMRpro Ambassador in reply to Christophene47]

The article I gave the link for is in the Journal of the American Society of

Anesthesiologists.

I don't live in the UK and use international sources for all my info.

[Christophene47 in reply to PMRpro]

Very good idea; there are differences in approach and opinion among different countries and medical cultures. In the US, if we could just resolve the issue of pain medication regulations without having another Civil War, it would be reassuring. I am afraid our federal agencies are rife with corruption and are in bed with the Big Pharma companies. I know corruption is everwhere, but taking pain meds away from good compliant patients and lumping them together with street addicts is reprehensible and insulting to both physicians and patients.

At least the American FDA has agreed to re-open the regulatory discussion with chronic pain patients and there will be a patient focused hearing; before which we can all submit comments electronically or in writing.

Frankly, I don't think government should have a role in the doctor-patient relationship at all. Next they will be monitoring the confessional in churches.

[PMRpro Ambassador in reply to Christophene47]

Much the same thing is about to happen here over cannibis oil as a result of the epileptic boy having CBD oil obtained for a clinical trial in Canada confiscated by UK customs - medicinal and street use isn't the same thing at all.

[Hidden]

Hi

The Anaesthetist is The Man or Women! They are the ones who look after you in theatre, he knows you are on Steroids, how long have you been on them & highest dose?

You can mention it to him again before he sends you to sleep, l had Hydrocortisone Cover in theatre when l had my mastectomy 3years ago & l was on 7.5mg Prednisolone.

They’ll be monitoring your blood pressure etc so try not to worry just mention it again on the day.

Good Luck 🍀 with your Surgery.

Mrs N 💅🏼

[Daylily2000 in reply to Hidden]

Thanks!

[Purplecrow]

No advice Daylily, just a big ol' hug and best wishes for successful surgery and easy recovery. 🌺🌸🌼

Kind Regards, Jerri

[Daylily2000 in reply to Purplecrow]

Thank you, Jerri! 🌹

[Daylily2000]

Well, I’m home recovering from my 5 hour surgery. All apparently went well and am mending now. The did infuse steroids during surgery, after all, and, while I was concerned about the steroids perhaps interfering with healing, a visit with my Rheumy yesterday which addressed my concern about this set my mind at ease. She said the steroids may actually enhance the healing process.

I want to thank those of you who responded to my concerns and help relieve my fear of having surgery while on prednisone! This group is amazing!