Steroids with general anaesthetic: Do I need to... - PMRGCAuk

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Steroids with general anaesthetic

maria40 profile image
28 Replies

Do I need to double the dose of my steroids (currently 11.5) on the day of hysteroscopy under general anaesthetic and also on the day afterwards? Preop assessment didn't mention it have just been reading around and feel really nervous now. Especially as I've been taking steroids for 21 years.

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maria40
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28 Replies
Mary63 profile image
Mary63

You will see the anaesthetist before the op as a matter of routine. He/ she will ask you what medication you take and give you hydrocortisone cover for the op. I have had 4 ops, (including a total knee replacement which went on much longer than expected) since I have been on prednisolone and there has been no problem. I did not need to change my dose before or after any op, and had no flares either.

maria40 profile image
maria40 in reply to Mary63

Thank you for that Mary, it's very reassuring. I seem to be worrying about every aspect of this relatively minor operation. I'm 81 and have never had a general anaesthetic before and losing sleep with anxiety. I also understand that one can't eat any solid food the next day and am wondering if I can keep the prednisolone down if one is allowed only liquids and prone to vomiting as I understand is often the case.

Mary63 profile image
Mary63 in reply to maria40

I know some people are sick after general anaesthetic, but I never was!

I think hysteroscopy doesn’t necessarily happen under GA, and maybe yours is because of your age?

Have you actually been told you will not be able to have solid food the next day? Or is it just because you are expecting to feel sick? Even if you are sick you can be given anti-emetics. Then you should be fine to eat and take your prednisolone.

It is understandable to be anxious, especially as you have reached your grand old age having never had a general anaesthetic, but all will be well....

Good luck

maria40 profile image
maria40 in reply to Mary63

I haven't been told I wouldn't be able to eat but it seemed to be the concensus in my trawl of Google that only water and clear liquid should be taken on the day afterwards. But perhaps as mine is a short procedure I'll be alright to eat the next day

MrsNails profile image
MrsNails in reply to maria40

Maria, the people who are often sick are under GA for sometime & may have been given Pain Meds (ie Morphine) as a precaution with having major surgery. You won’t be in theatre long & it’s unlikely you’ll have a very deep anaesthetic so don’t be worried about being sick. If however you were sick they’d give you your Pred Dose by injection.

Make sure you take a Full List of your Meds in with you including your Pred, the Nurse OK’d me to take my Own Meds the following morning.....

maria40 profile image
maria40 in reply to MrsNails

I had asked if I could stay in overnight but was told they may not have a bed and if not the procedure would have to be cancelled again and I cannot bear further delay so I'll be staying at my daughter's house ( which is a bit chaotic) and will have to take my next day dose there. My expectation had been that I would starving after having breakfast at 7.30 on the day before. So perhaps it's just light food rather than the few sips of water which I've seen recommended on some sites.

MrsNails profile image
MrsNails in reply to maria40

Sometimes you can read too much.....

You should be able to eat, even if it’s only Tea n Toast, they may ask you to eat something on the Ward before you leave.

maria40 profile image
maria40 in reply to MrsNails

Thanks so much Angela.

That was exactly what I had envisaged. Think I'll sleep a bit better having talked on here. Ten days is a long time to wait and I mustn't cross bridges before I come to them as my daughter is always telling me.

MrsNails profile image
MrsNails in reply to maria40

Always best to get the information you need, someone has always got an experience.

PuttyPenguin profile image
PuttyPenguin in reply to MrsNails

Exactly right! I can't take morphine as I'm as sick as dog.

Highlandtiger profile image
Highlandtiger in reply to maria40

I’ve had quite a few general anaesthetics and have always been given solid food after I’ve come round and recovered from the anaesthetic. I’ve never vomited after an anaesthetic although I can be quite prone to vomiting otherwise so please don’t worry too much about that.

Telian profile image
Telian in reply to maria40

Hi Maria,

I’ve had 14 surgeries with general anaesthetic and used to suffer sickness but as time went on they’ve introduced new anti sickness meds and they do work. In your case you have no record of sickness so don’t think about that. You will see the wonderful anaesthetist before your surgery when you can share all your anxieties. I had intravenous steroid during and after surgery, was on 40mg pred). You needn’t worry about anything but it’s normal to. You will be well looked after and they won’t discharge you until you’re fit to go regardless of bed shortage.

You’ll get tea and toast,something light, shortly after surgery so don’t worry about anything. Think about that delicious first cuppa. 🌺

maria40 profile image
maria40 in reply to Telian

Thanks for you reassurance Telian. I just long for it all to be over and have 9 more days to go on worrying though I know it doesn't help.

Telian profile image
Telian in reply to maria40

You can’t help it so take each day at a time - until you’re exhausted then you will stop - that’s happened to me too. 🌺

maria40 profile image
maria40 in reply to Telian

I think I'm close to the point of exhaustion now. I wake at about 3.30 every day and can't get back to sleep. I know it's pointless but can't stop. But it's so good to have people who understand. Thank you.

Telian profile image
Telian in reply to maria40

I do that regardless - my steroid brain just doesn’t let go particularly when I go to bed. I try to concentrate on nothing or just count and it seems to help me.

MrsNails profile image
MrsNails

Hi Maria

I’ve posted about this exact topic & it’s on our FAQ - l’ll send you a link.

You stay on your Steroid Dose & ensure both the Surgeon & the Anaesthetist are aware of your dose & how long you have been on them.

Depending on your dose now, depends on the what you’ll be given in Theatre as Hydrocortisone & then you’ll be advised if you need to alter your dose at all.

Kind Regards & Good Luck 🍀

MrsN

patient.info/doctor/precaut...

maria40 profile image
maria40 in reply to MrsNails

Thanks so much. I don't know what I'd do without you all on this forum. I had looked at the information on the new steroid card and started to wonder then made the mistake of looking at Dr Google. I was not so worried before my first attempt to have this procedure which was called off because of my elevated heart rate. Beta blockers have now been raised so I hope that will not be a problem - unless I worry too much that is.If I'm awake at 3.30 again tomorrow morning I'll log on here and find some calm.

PMRpro profile image
PMRproAmbassador

This is a question to take to the anaesthetist and take your tablets with you in case you need them.

diana1998 profile image
diana1998

Please don't worry, it's a very simple op and a light anaesthetic. You will be fine I'm sure and will be able to eat afterwards. I had this op before pred, but it was a doddle. The worry before is far worse than the experience. Good luck and relax. You will be well looked after.

maria40 profile image
maria40 in reply to diana1998

Thanks Diana. You're certainly right about the worry. I'm really no getting much sleep at the moment and lying awake worrying. Your experience is reassuring.

USAGCA profile image
USAGCA

Hi. You will need supplemental steroids, which can be given intravenously on the day of surgery as you roll into the OR. You don’t need to take any oral steroids on the day of surgery, especially if they irritate your stomach. They should give you anti emetics like ondansetron and possibly, dexamethasone (another steroid). You should be fine with the nausea if you minimize the use of opiate narcotics for pain.

maria40 profile image
maria40 in reply to USAGCA

I have been told at the preop assessment to take my steroids on the morning of the operation. I do take enteric coated tablets so stomach irritation should be avoided. I also understand from others on the forum that I should take oral steroids the next day as usual. Perhaps procedures differ in the USA and UK?

USAGCA profile image
USAGCA in reply to maria40

Agree. Things are different in the US. We discourage the use of oral steroids on an empty stomach the day of surgery . We certainly don’t ask patients to take extra oral doses that day. However, oral steroids the next day for s fine here too.

PMRpro profile image
PMRproAmbassador in reply to USAGCA

They don't ask patients to take extra oral pred on the day of surgery - and it depends on the procedure. A scope that takes just a few minutes as opposed to a longer surgical procedure might not justify extra i.v. steroid cover but just close monitoring. It all depends on the anaesthetist.

Twopies profile image
Twopies in reply to USAGCA

I’m in u.s. they always tell me to take my steroids the day of surgery as usual. Last time I asked the anesthesiologist whether I should up my dose before surgery; he said “no, I’ll give you plenty during the procedure,” and he must have because I woke up feeling better than when I went in. Although despite the anti nausea meds, I was sicker than a dog all the next day.

anutycrixp profile image
anutycrixp

I had a big op recently with nerve block and general anaesthetic.I was so anxious beforehand,afraid.I just "gave in" when I arrived on the day of the surgery and let the staff do their job..I was able to express my fears and just let them deal with all the meds etc.Later that day kindly voices woke me up,gentle attention was given to my needs,there was no pain or vomiting[which I was afraid of!!]That evening I enjoyed plenty of tea and a really nice supper.Then slept peacefully that night.Next day I was able to go home.Thinking back I realise a lot of my anxiety beforehand is about not being in control and trust.When having operations you can't be in control because aneathesised,so just have to let go.I hope all goes well for you,best wishes.!

maria40 profile image
maria40

I think you've got it completely right. I like to know what's happening and be in control and now I have to let go and trust others. Thanks for your good wishes.

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