Tapering Pred & General Anaesthetic

[Caro12line]

Hello.. Question please. I am due to go in next Thursday for fixed Cystoscopy under General Anaesthetic. Went for my pre op assessment today and all ok. But I have recently tapered to 7mg (been on Pred for a year) using the dead slow and stop and just wondered if I should up it a day before and the day of the Op. I did ask the Pre Op assessment nurse today and she didn't have a clue. My worry is that being on 7mg I am doing really well, but I don't know how much stress GA puts your body through and I don't want to flare (GCA) and have to go back up to high dose. Thanks

[Suzym2u Moderator Vasculitis UK]

I think the consultant who is doing the Cystoscopy and the consultant who treats you for the GPA should have a case conference before the operation.

John has had two ops with GA and with both ops the Urologist and the doctor who treats J for the Vasculitis had a case conference.

The Urologist told John he had no idea about Vasculitis or GPA and would not do the op without consultation.

hope this helps.

Susan

[Caro12line in reply to Suzym2u]

Thank you... I do suffer from lack of "whole health" treatment..no joined up thinking in my, what I call add on problems, probably caused by high dose Pred to get the GCA under control. GP diagnosed Microscopic Hematuria after a UTI, hence the Cystoscopy... Rheumatology are aware that this is under investigation. But it just worries me that the tapering has not been taken into account and I am sure my adrenal are at best very sluggish after a year on Pred. Think I will phone rheumatology nurse in the morning to pose the same question.... My dilemma is I have been waiting since September for this, two cancelled ops due to Shingles and then Pluerisy... CT of kidneys is clear so if there is a problem with my bladder I want to know and get it sorted

[PMRpro in reply to Caro12line]

Cystoscopy is a minor procedure and, as Keyes has said, the GA isn't the sort of GA you get for "real" surgery, it is very light. I've had 3 done - all of them without even pain relief never mind anaesthetic so you can see it isn't too bad at all and the last time was while on pred - if I remember rightly at probably 15mg and possibly 20mg.

The modern thinking about pred during surgery is not to raise the oral dose but sometimes to give some intra-op - and that is for surgery such as hip replacements and so on. Two ladies with PMR who have had hip replacements were told it was important to be stable on their current dose and not to be in the throes of reducing at the same time. As Keyes' link says - the risk of infection is raised with too much pred so it was decided some years ago to stop the routine increase of pred before surgery and leave it to the anaesthetist during the procedure.

Can you contact the anaesthetics department at the hospital? I'm not sure your rheumatology nurse will be much use - I was going to say lucky you but the only experience I had with a rheumatology nurse was she didn't return my call. Ever.

[Hidden]

Hi Caro12line,

I hope the procedure goes ok. I think it's a very light anaesthetic not a full GA for these procedures.

Really the pre op assessment nurse should have checked with the anaesthetist and provided you with the information.

[Hidden]

Have found this link. My reading of it is because you are on under 10mg then it should be fine. Still run it by the Rheumy nurse though!

patient.info/doctor/Precaut...

[Caro12line]

Thank you all very much for your replies. And yes all makes sense. The lower the dose the lower the risk of infection and yes they did say it was a very light anaesthetic "hardly out at all" so I will stay at 7mg and mention it to the anaesthetist on the day. Thank you all again for your wise words.

[Galaxy2]

Hi There

Good luck for next Thursday, I am also having a GA on Monday and hadn't even thought about my pred dose so will be asking the question now. That's what's so good about this site, more information than we get from medical professionals at times.

Hope it goes well

Jenny

[determined56]

Hi good luck with procedure having taken steroids for a few years(60 years nearly!) I just take normal dose am with iv top up in minor procedures . Have S1 deep injections under light anaesthetic & other procedures .

However you must get aneathetist to liaise with the consultant prescribing steroid / endo could be consulted for guidance as we are all different in the way we react under stress situations .

Even after all my years light procedures and minor ops there is a lack of knowledge over steroid cover ......if I have trouble getting with it after I just take an extra dose of pred with a cup of tea at the hospital.

Hugs to all

[Caro12line in reply to determined56]

Thank you determined56. All went well. I expressed my concerns to the aneathetist and she assured me she would keep a check and all would be fine. I woke up in recovery after about 45 minutes of being in the pre op room. I had a drip which they said was just saline for rehydration. I spent about 15 minutes in recovery then back to the ward. Obs were fine, they removed drip and I had a sandwich and a much needed cup of tea! I felt fine. After eating I passed urine (they said I had to, in sufficient volume before I went home). all fine, got dressed and husband came and picked me up. Felt tired, early night, next morning up as normal and no ill feeling since. I have stayed a 7mg Pred all week, had routine bloods done on Wednesday, will phone tomorrow for results and if all ok CRP & WBC then I will go for a slow slow drop to 6mg. Thank you so much for your kind thoughts. X

[determined56]

Glad all over .....let us know how it all went.Nothing quite like that cup of tea after....

Hugs for you

[Caro12line in reply to determined56]

Good news. Had the Cystoscopy because urine test after a UTI showed microscopic Hematuria. CT of kidneys was clear. Uro surgeon found nothing abnormal in my bladder. So why the Hematuria I asked? He said for reasons unknown some people have this for no apparent reason or it could be the Prednisolne (I have been on it a year) he was interested when I told him I have high blood calcium and I wondered if the extra calcium being passed was causing irritation. But he found no evidence of stones or bladder irritation... But I still think that maybe the cause. Perhaps in the bit (sorry don't know the name) between kidney and bladder? X