prednisone coverage during surgery

Dr. Pho, I am a 68yo black female who was Dx with Giant Cell Temporal Arteritis 4 years ago and have been on prednisone therapy since the Dx,I started at 60 mg and had a SED rate of 145 at that time, I have had several infections during this time and had to up the dose, I a now being weened 5mg alternating with 21/2 every other day. I am due for cataract surgery 4/19/04 none of my Drs. seem to think that I need extra cortisone therapy for this surgery, i'ts being done under general anesthesia due to a movement disorder. I am very anxious about this as I have tried to keep myself informed about this disease which has lasted longer than I expected,and was not Dx. by my personal physcian ,I was sent to a larger diagnostic hospital for the DX.as they could not come up with anything here. The information I have read up on says I need coverage during surgery even a year of being off the prednisone, I may be wrong but that does not stop my concern.Should I be more assertive? about my feelings or just go along with people I don't feel know enough about my disease. thank you , Marva

[Kevin Pho, MD]

Several authors have recommended that patients on chronic glucocorticoids undergoing surgery receive only their usual daily dose of glucocorticoid perioperatively. These recommendations are based upon studies that have shown that no surgical patient who was treated with his usual steroid dose developed intraoperative or postoperative hypotension or any other perioperative signs of adrenal insufficiency.

In general, patients who have taken any dose of glucocorticoids for less than three weeks or who have taken chronic alternate day therapy should continue on their usual dose of glucocorticoids perioperatively. In contrast, hypothalamic-pituitary-adrenal (HPA) axis suppression should be assumed to be present in patients taking prednisone at a dose greater than 20 mg/day for three weeks or more.

In your case, the dose of steroids you are taking is less than 20 mg/day, thus it is likely that your normal dose is sufficient.  You may want to discuss this with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Welsh et al.  The surgical patient taking corticosteroids.  UptoDate, 2004.