missing prednisone dose before hip surgery

[arvine]

I am currently on 4 mgs of pred since last April, which surgeon and anesthesiologist aware of, hip replacement in few days, usually take pred in morning with food, instructions prior to surgery at 8 am are no food after midnight, no water coffee etc after 5 am that morning, and after surgery no solid food that day, I will check again , call hospital on tuesday, but wondering if anyone out there have experience or advice on this issue?

[piglette]

When I had my hip done I took my pred early for me, just before midnight with yogurt. My surgery was about 1pm the following day.

[PMRpro Ambassador]

The usual solution is to take it the night before. You will also get hydrocortisone in the infusion set up for the operation and the anaesthetist will oversee that. Make sure they know you are a longterm steroid patient - the ANAESTHETIST, not just a nurse.

[arvine in reply to PMRpro]

Oh ok so surgery is this thursday morn 8?am, and wednesday morning I take my usual dose with breakfast then you re saying take another 4?mgs wed night before midnight? i did tell them at pre op was long term pred

[PMRpro Ambassador in reply to arvine]

Yes, it's just a bit early, but it should keep you more comfortable next day.

All the best for the surgery!

[arvine in reply to PMRpro]

Ok thank you

[Gimme in reply to PMRpro]

I have an idea that I checked the half life for hydrocortisone after my hysteroscopy and found that the half life is much longer than prednisolone. I always have some residual stiffness and soreness after taking my pred and I had two days pain free after the op, which is what made me think that. That's just off the top of my head, as I want to get out early today. I'll check when I get back. Anyway, for arvine, if my own experience is anything to go by, I am sure you will be adequately covered, so long as the anaesthetist is aware. The nurse told me to keep my steroid band on my wrist when I went into theater, just to be sure.

[PMRpro Ambassador in reply to Gimme]

Are you sure t wasn't dexamethasone that was used? Hydrocortison is definitely short-acting, pred intermediate acting.

"Multiple types of oral steroids are commonly used in children. Dexamethasone (36–54 hours) has a longer biological half-life than prednisolone (18–36 hours); hydrocortisone (6–12 hours) has the shortest half-life. As shown in Table 1, 100 mg hydrocortisone is equivalent to 25 mg prednisolone and 4 mg dexamethasone.9 Extent of linear growth inhibition is related to the steroid used, with longer-acting steroids more likely to affect growth;10 dose and duration of exposure determine the extent, which is most pronounced when administered daily rather than alternate daily.5

Table 1. Relative potencies (approximate dose equivalent to 25 mg prednisolone) and half-lives of commonly used oral steroids

Oral steroid Approximate dose equivalent Duration of action Biological half-life

Hydrocortisone 100 mg Short acting 6–12 hours

Prednisolone 25 mg Intermediate 18–36 hours

Dexamethasone 4 mg Long acting 36–54 hours

www1.racgp.org.au/ajgp/2021....

[Gimme in reply to PMRpro]

You could be right. I suppose it is possible. There was an intern checking me before the procedure and I heard the anaesthetist say, don't worry she will get hydrocortisone when she's under, but I guess that anything can happen after you've been knocked out, if they see a medical need. It was only afterwards that I commented to my friend how much better I had been feeling, and she said, are you sure that it isn't something they gave you. I suppose that illustrates the dangers of anecdotal evidence.

[Viv54]

It is amazing how hospitals differ ! Iam on 7.5 of Pred .I was told to carry on taking them as normal but cut down on BP tablets 2 days before. Good Luck with your op.

[Viv54 in reply to Viv54]

Ps, same as others i kept my band on.