Budesonide Nasal Spray Before General Anesthesia
Continue budesonide nasal spray on the morning of surgery without interruption. There is no evidence that intranasal corticosteroids interfere with anesthesia or increase perioperative risk, and stopping them may worsen underlying sinonasal disease.
Safety Profile Supporting Continuation
Budesonide nasal spray demonstrates excellent safety even with long-term use:
- Multiple randomized controlled trials show no serious adverse events with budesonide nasal spray at therapeutic doses (128-400 μg daily) for treatment periods ranging from 4 weeks to 1 year 1
- The most common adverse effect is blood-tinged nasal secretions, which occurs at similar rates to placebo 1
- No clinically meaningful hypothalamic-pituitary-adrenal axis suppression occurs at doses up to 4-fold higher than the recommended starting dose 2
- 24-hour urinary free cortisol levels remain normal with standard therapeutic doses 1
Lack of Anesthetic Interactions
Intranasal corticosteroids have no documented interactions with general anesthesia:
- The perioperative medication management guidelines do not list intranasal corticosteroids as requiring discontinuation before surgery 1
- Budesonide nasal spray acts locally with minimal systemic absorption when used at therapeutic doses 2, 3
- There are no contraindications to continuing topical nasal corticosteroids perioperatively
Clinical Rationale for Continuation
Stopping budesonide nasal spray offers no benefit and may cause harm:
- Patients with chronic rhinosinusitis benefit from continuous therapy, with symptom improvement occurring within 1-2 days of starting treatment and worsening upon discontinuation 4
- Budesonide significantly improves nasal obstruction, rhinorrhea, postnasal drip, and sense of smell in patients with chronic rhinosinusitis 1
- Postoperative continuation of budesonide reduces polyp recurrence rates after sinus surgery 1
Important Caveat
Monitor for adrenal suppression only in high-risk patients:
- Asymptomatic hypothalamic-pituitary-adrenal axis suppression may occur in 23% of patients using long-term budesonide nasal irrigations (>6 months), particularly when combined with both nasal steroid sprays and pulmonary steroid inhalers 5
- Standard budesonide nasal spray (not irrigations) at therapeutic doses carries minimal risk of adrenal suppression 2, 3
- Patients using multiple forms of corticosteroids concurrently warrant closer monitoring, though routine testing is not necessary for isolated nasal spray use 5