From the Guidelines
Steroids should be administered before anesthesia to reduce inflammatory airway oedema, with a recommended dose equivalent to 100 mg hydrocortisone every 6 hours, starting as soon as possible in high-risk patients and continuing for at least 12 hours. The use of steroids before anesthesia has been shown to reduce inflammatory airway oedema resulting from direct airway injury, such as surgical or anaesthetic trauma 1. This is particularly important in patients who are at high risk of developing airway oedema, as it can help to prevent complications such as upper respiratory obstruction or stridor. In terms of specific dosing, the evidence suggests that all steroids are equally effective, provided they are given in adequate doses, with a recommended dose equivalent to 100 mg hydrocortisone every 6 hours 1. Additionally, a study published in 2013 found that administering corticosteroids before induction with anesthesia for thyroid surgery can reduce postoperative nausea and vomiting, as well as pain, without increasing adverse effects 1. However, it is essential to note that single-dose steroids given immediately before extubation are ineffective, and steroids should be started as soon as possible in high-risk patients and continued for at least 12 hours 1. Some key points to consider when administering steroids before anesthesia include:
- Starting steroids as soon as possible in high-risk patients
- Continuing steroids for at least 12 hours
- Using a dose equivalent to 100 mg hydrocortisone every 6 hours
- Being aware that single-dose steroids given immediately before extubation are ineffective
- Considering the use of corticosteroids to reduce postoperative nausea and vomiting, as well as pain, in patients undergoing thyroid surgery 1.
From the FDA Drug Label
During stress it may be necessary to increase dosage temporarily. The FDA drug label does not answer the question.
From the Research
Steroid Use Before Anesthesia
- The use of steroids before anesthesia has been studied in various contexts, including airway management and postoperative complications.
- According to 2, adrenal corticosteroids can suppress the inflammatory response that leads to tissue swelling, and can be effective in treating upper airway obstruction caused by edema.
- The study 3 found that prophylactic administration of multiple-dose dexamethasone can reduce the incidence of postextubation stridor in adult patients at high risk for postextubation laryngeal edema.
Risks and Benefits
- However, preoperative steroid use has also been associated with increased postoperative complications, including superficial and deep surgical site infections, organ/space infections, and mortality, as reported in 4.
- On the other hand, steroids can be beneficial in minimizing the risks of perioperative respiratory complications in patients with asthma undergoing general anesthesia, as noted in 5.
- Inhaled steroids have been shown to be effective in reducing airway inflammation and remodelling in asthma, with high doses able to reduce airway wall vascularity and basement membrane thickness, as reported in 6.
Key Considerations
- The decision to use steroids before anesthesia should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.
- The benefits of steroid use in reducing postextubation stridor and minimizing perioperative respiratory complications must be weighed against the potential risks of increased postoperative complications.
- Further research is needed to fully understand the effects of steroid use before anesthesia and to develop evidence-based guidelines for clinical practice.