Preoperative Administration Of Steroids Research Articles

Combining intralesional steroid injection with oral steroids in patients with idiopathic granulomatous mastitis.

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease. Currently, there is no international standard for steroid use in IGM, particularly for intralesional steroid injections. This study aimed to determine whether patients with IGM who received oral steroids could benefit from intralesional steroid injection. We analyzed 62 patients with IGM whose main clinical presentation was mastitis masses and who received preoperative steroid therapy. Group A (n = 34) received combined steroid treatment: oral steroids (starting dose, 0.25 mg/kg/d; tapered off) and intralesional steroid injection (20 mg per session). Group B (n = 28) received oral steroids only (starting dose, 0.5 mg/kg/d; tapered off). Both groups underwent lumpectomy at the end of steroid treatment. We analyzed the preoperative treatment time, preoperative mass maximum diameter reduction rate, side effects, postoperative satisfaction, and rate of IGM recurrence. The mean age of the 62 participants was 33.6 ± 2.3 (range, 26-46) years, and all had unilateral disease. We found that oral steroids combined with intralesional steroid injection yielded better therapeutic effects than did oral steroids alone. The median maximum diameter reduction of the breast mass was 52.06% in group A and 30.00% in group B (P = .002). Moreover, the use of intralesional steroids reduced the duration of oral steroid use; the median durations of preoperative steroid therapy were 4 and 7 weeks in groups A and B, respectively (P < .001). Group A patients were more satisfied (P = .035) with the postoperative results, including postoperative appearance and function. No statistically significant between-group differences were noted regarding side effects and recurrence rates. Preoperative administration of oral steroids combined with intralesional steroid injection yielded better therapeutic effects than did oral steroids alone and may be an effective future treatment for IGM.

Effect of preoperative systemic corticosteroids on intraoperative bleeding during sinonasal polyposis surgery

This prospective study was done to evaluate the effect of preoperative systemic corticosteroids on intraoperative bleeding during sinonasal polyposis surgery. Materials and Methods: A Total of 70 patients with age between 10-60 years were studied from the in-patient department. All the cases meeting the inclusion and exclusion criteria underwent Diagnostic Nasal endoscopy, CT scan and were divided into 2 groups of 35 each. Group A (35) received oral prednisolone 1mg/kg/day for 5 days prior to surgery and Group B (35) severed as control. The patients were operated under general anaesthesia, the bleeding volume and surgical field visibility was recorded. Postoperatively patients were followed up once weekly for 4 weeks. Results: Better surgical field conditions were the results of the powerful anti-inflammatory and antiedematous activity of the drug, which facilitated blood and secretion evacuation from the operated area providing a better surgical field visibility. Conclusion: In conclusion pre-operative administration of oral steroids reduces intra-operative bleeding and early post-operative complications.

Effect of preoperative oral administration of steroids in comparison to an anti-inflammatory drug on postoperative pain following single-visit root canal treatment - a double-blind, randomized clinical trial.

This randomized, double-blinded, clinical trial evaluated the effect of oral premedication of piroxicam, prednisolone, dexamethasone or placebo on postoperative pain after single-visit root canal treatment in teeth with symptomatic irreversible pulpitis and symptomatic apical periodontitis. The trial is reported according to the Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE) 2020 guidelines. The protocol was registered at the clinical trial registry (India) (CTRI/2019/06/019818). In total, 160 patients, assigned to four groups, received orally either 20mg piroxicam, 20mg prednisolone, 4mg dexamethasone or a placebo 60min before root canal treatment. Patients recorded their postoperative pain intensity at 6, 12, 24, 48 and 72h using a 10-cm visual analogue scale. Intergroup comparison was performed using Kruskal-Wallis tests with post hoc analysis using Dunns test. Incidence of pain was analysed using chi-square tests. A P value<0.05 was considered to be statistically significant. Binary logistic regression was used to determine the odds of postoperative pain, with incidence of pain as the dependent variable and intervention groups, gender, age and type of tooth as independent variables. In total, 156 patients were analysed in the trial, since four patients dropped out during follow-up. All drugs were associated with a significantly lower incidence of postoperative pain compared to the placebo at 6h (P=0.009), 12h (P=0.003) and 24h (P=0.008). Mean intensity of pain was significantly more intense at 6, 12 and 24h with the use of placebo in comparison to the other three intervention groups (P<0.05). Intensity of pain was not significantly different between the premedications used (P>0.05). One patient in the piroxicam group reported gastritis, whereas no adverse effects were recorded in other groups. Preoperative oral administration of a single dose of 4mg dexamethasone, 20mg piroxicam or 20mg prednisolone reduced the incidence and severity of postoperative pain following single-visit root canal treatment compared to a placebo in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis up to 24h. The odds of postoperative pain at 24h for patients premedicated with 4mg dexamethasone or 20mg piroxicam or 20mg prednisolone were 5.3 times, 3.4 times and 2.5 times less compared to the placebo, respectively.

Does the Preoperative Administration of Steroids Reduce Intraoperative Bleeding during Endoscopic Surgery of Nasal Polyps?

Corticosteroids are frequently used in a range of otorhinolaryngologic conditions due to their anti-inflammatory and antiedematous properties. In this meta-analysis, we aimed to assess the role of preoperative steroids for attenuating intraoperative bleeding during endoscopic sinus surgery among patients with nasal polyps. PubMed, SCOPUS, EMBASE, the Web of Science, and Cochrane database. Literature was screened from January 1980 to January 2016. Five articles comparing patients who were preoperatively administered steroids (steroid groups) with patients who received a placebo or no treatment (control group) were included for analysis, which encompassed intraoperative bleeding, endoscopic surgical field visibility, operative time, and side effects during endoscopic sinus surgery. Intraoperative bleeding and operative time during endoscopic sinus surgery in the steroid group were significantly reduced as compared with the control group. Additionally, the preoperative administration of steroids had a significant effect on improving endoscopic surgical field visibility during sinus surgery. There were no significant adverse effects reported in the enrolled studies. In subgroup analyses of these results, steroids showed similar effects on intraoperative bleeding regardless of administration type (topical or systemic). This study demonstrated that the preoperative administration of steroids in patients with nasal polyps could effectively reduce intraoperative bleeding. However, the duration of treatment and dosing standard require further investigation, and more trials need to be included.

Use of Corticosteroids in third molar surgery: Review of literature

Surgical removal of impacted tooth is one of the common procedures done by oral and maxillofacial surgeons in their day-to-day practice. Surgical removal of impacted tooth produces swelling, pain, and trismus postoperatively. Corticosteroids (CS) have been used in effectively reducing these postoperative sequelae after surgical removal of impacted third molars. Various doses and types of steroids are used. Here, a systematic search of literature was carried out using various doses, types, and routes of administration of steroids in mandibular third molar impaction as key words. Only most relevant articles were included ( n = 24). Administration of CS improves the postoperative experience of patients and has a significant impact on trismus and inflammation. The dosage of steroids should be more than the physiological amount produced in the body. The duration of action of the steroid administered also affects the results. Long-acting steroids give better results than short-acting one. If short-acting steroids are given, they have to be supplemented for a minimum of 2 days to a maximum of 5 days. Preoperative administration of steroids is found to be more effective than postoperative administration. Submucosal administration of steroids produces similar effects to intravenous and intramuscular routes.

The influence of steroid administration on systemic response in laminoplasty for cervical myelopathy

The excessive systemic inflammatory response caused by surgery has been associated with the development of major complications, such as postoperative confusion and acute respiratory distress syndrome. The serum IL-6 has been used as a predictor in the extent of surgical trauma. Several trials have reported that steroid administration reduced excessive systemic response. We investigated the systemic response caused by surgical trauma in patients with cervical laminoplasty and evaluated the influence of steroid administration on systemic response. Thirty patients were included in this study. The patients were divided into three groups of ten each: preoperative steroid group, intraoperative steroid group, and non-steroid group. The same dose of steroid was administered to the patients in preoperative group and intraoperative group. Venous blood samples were taken at the following times: before surgery, at the end of surgery, 6 h after the surgery, the first, the third and the seventh day after the surgery. Outcome measures were serum IL-6, IL-10, C-reactive protein (CRP), white blood cells including neutrophil and lymphocyte counts. The mean serum IL-6 levels on the first day in preoperative and intraoperative steroid groups were significantly lower than in control group. The serum IL-6 levels in preoperative steroid group were lower than the serum levels in the intraoperative steroid group from the end of surgery to the third day after surgery. The CRP levels in steroids groups were also lower than in control group on the third day. There were no significant differences in the postoperative neutrophil count between the three groups. There was no postoperative infectious complication or suture failure. This study shows that the preoperative administration of steroids modified the systemic inflammatory response caused by surgical trauma in patients with cervical laminoplasty.

Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Thyroidectomy: Meta‐analysis of Randomized Controlled Trials

Postoperative nausea and vomiting (PONV) is a common complication after thyroidectomy. Steroids effectively reduce nausea, pain, and inflammation; therefore, preoperative administration of steroids ought to improve these surgical outcomes. We conducted a systematic review of randomized controlled trials (RCTs) that compared preoperative single-dose administration of dexamethasone with no dexamethasone in patients undergoing thyroidectomy. The primary outcome was occurrence of PONV within 24 h, and the secondary outcomes were pain, use of analgesics, and steroid-related complications. Five RCTs were included with a total of 497 patients. A statistically and clinically significant difference in the incidence of PONV was found in favor of dexamethasone [relative risk (RR) 0.38; 95% confidence interval (CI) 0.30-0.49). The visual analog pain score was significantly diminished (weighted mean difference, WMD)-1.50; 95% CI-2.54 to -0.46) at 24 h. The incidence of analgesics use was also reduced (RR 0.61; 95% CI 0.41-0.90) in the dexamethasone group. No steroid-related complications were noted. A single preoperative administration of dexamethasone reduced the incidence of PONV and analgesic requirements in patients undergoing thyroidectomy. Prophylactic use of steroids for patients undergoing thyroidectomy is safe and should be considered for routine clinical practice.

Intraoperative 5-aminolevulinic-acid-induced fluorescence in meningiomas

5-aminolevulinic acid (5-ALA) has gained importance as an intraoperative photodynamic diagnostic agent for the extirpation of malignant gliomas. The application of this technique for resection of meningiomas has barely been explored. The aim of this study was to evaluate the utility of 5-ALA-induced fluorescence as a visual tool in meningioma resection and its correlation with histological findings. A total of 33 consecutive patients undergoing resection of intracranial meningiomas from December 2007 to August 2009 were included in this study. After confirmation of normal liver function, 5-ALA was administered orally (20 mg/kg) within 3-5 h prior to skin incision. All cases were operated on using standard microsurgical and neuronavigation-guided techniques. Intraoperative 440 nm fluorescence was applied periodically during and at the end of resection in order to detect tumor-infiltrated sites. The fluorescence of the tumor was evaluated intraoperatively by the surgeon and confirmed by subsequent video analysis. A total of 32 (97%) patients presented with benign meningiomas (WHO I-II). In 1 (3%) patient, histological anaplastic signs (WHO III) could be demonstrated. 5-ALA-induced fluorescence of the tumor was confirmed in a total of 31 (94%) patients. The fluorescence did not correlate with the histological findings (n = 30 WHO I-II, n = 1 WHO grade III) or with preoperative brain edema and administration of steroids. A total resection could be postoperatively demonstrated in 25 (76%) patients. No adverse effects attributable to 5-ALA occurred. 5-ALA-induced fluorescence is a useful and promising intraoperative tool for the visualization of meningioma tissue. The novel findings demonstrated in this study in terms of high fluorescence and poor correlation with histological findings highlight the usefulness of this technique as a routine visual tool to achieve optimal resection of meningiomas.

Randomized Controlled Trial on Single Dose Steroid Before Thyroidectomy for Benign Disease to Improve Postoperative Nausea, Pain, and Vocal Function

To evaluate the effects of a single preoperative dose of steroid on thyroidectomy outcomes. Nausea, pain, and voice alteration frequently occur after thyroidectomy. Because steroids effectively reduce nausea and inflammation, a preoperative administration of steroids could improve these thyroidectomy outcomes. Seventy-two patients (men = 20, women = 52) undergoing thyroidectomy for benign disease were included in this randomized, controlled, 2 armed (group D: 8 mg dexamethasone, n = 37; group C: 0.9% NaCl, n = 35), double-blinded study (clinical trial number NCT00619086). Anesthesia, surgical procedures, antiemetics, and analgesic treatments were standardized. Nausea (0-3), pain (visual analog scale), antiemetic and analgesic requirements, and digital voice recording were documented before and 4, 8, 16, 24, 36, and 48 hours after surgery. Patients were followed-up 30 days after hospital discharge. Baseline characteristics were similar among the 2 treatment groups. Nausea was pronounced in the first 16 hours postoperatively (scores were <0.3 and 0.8-1.0 for group D and C, respectively (P = 0.005)), and was significantly lower in group D compared with group C during the observation period (P = 0.001). Pain diminished within 48 hours after surgery (visual analog scale 20 and 35 in group D and C, respectively (P = 0.009)). Antiemetic and analgesic requirements were also significantly diminished. Changes in voice mean frequency were less prominent in the dexamethasone group compared with the placebo group (P = 0.015). No steroid-related complications occurred. A preoperative single dose of steroid significantly reduced nausea, vomiting, and pain, and improved postoperative voice function within the first 48 hours (most pronounced within 16 hours) after thyroid resection; this strategy should be routinely applied in thyroidectomies.

Preoperative administration of steroids: influence on adhesion molecules and cytokines after cardiopulmonary bypass

Background. Cardiopulmonary bypass (CPB) is associated with tissue damage mediated by adhesion molecules and cytokines. Prebypass steroid administration may modulate the inflammatory response, resulting in improved postoperative recovery. Methods. Fifty patients undergoing elective coronary operations under normothermic CPB were randomized into two groups: group A (n = 24) received intravenous methylprednisolone (10 mg/kg) 4 hours preoperatively, and group B (n = 26) served as controls. Cytokines (tumor necrosis factor-α [TNF-α], interleukin-2R [IL-2R], IL-6, IL-8), soluble adhesion molecules (sE-selectin, sICAM-1), C-reactive protein, and leukocytes were measured before steroid application, then 24 and 48 hours, and 6 days postoperatively. Adhesion molecules were measured by enzyme-linked immunosorbent assay, cytokines by chemiluminescent immunoassay. Postoperatively, hemodynamic measurements, inotropic agent requirements, blood loss, duration of mechanical ventilation, and intensive care unit stay were compared. Results. Aortic cross-clamp and CPB time was similar in both groups. Prednisolone administration reduced postoperative levels of IL-6 (611 versus 92.7 pg/mL; p = 0.003), TNF-α (24.4 versus 11.0 pg/L, p = 0.02), and E-selectin (327 versus 107 ng/mL, p = 0.02). Postoperative recovery did not differ between groups. Conclusions. Preoperative administration of methylprednisolone blunted the increase of IL-6, TNF-α, and E-selectin levels after CPB but had no measurable effect on postoperative recovery.

乳幼児の気管・気管支異物症例

We reviewed 14 cases of tracheobronchial foreign bodies in infants treated between 1982 and 1996 at the Osaka Red-Cross Hospital. In all cases, the foreign bodies were successfully removed using a ventilation bronchoscope under general anesthesia. The most common foreign body was a peanut, as noted in other reports. Chest X-ray findings suggested hype lucency in 7 cases, pneumonia in 2 and mediastinal shift in 2, while there were no remarkable changes found in 3 cases. Major signs and symptoms were dyspnea, wheezing and coughs in 13 cases, fever in 10 and cyanosis in 7. Preoperative administration of steroids was effective in facilitating removal of a lonstanding foreign body. We suggest that steroids should be preoperatively administered to patients who have retained a foreign body for a long period.

The Use of Heliox and the Laryngeal Mask Airway in a Child with an Anterior Mediastinal Mass

he patient with an anterior mediastinal mass and respiratory distress presents one of the most difficult problems in anesthetic management. When the mass is a malignancy, patients require an accurate tissue diagnosis to determine the optimal therapy, which may limit the preoperative administration of chemotherapy, steroids, or radiotherapy. Nonmalignant masses, such as teratomas and cystic hygromas, are not amenable to such therapy. Numerous reports in the anesthesia literature have described both the pitfalls and the optimal management of these patients. We report the use of heliox, a gas containing 20% oxygen and 80% helium, and the laryngeal mask airway (LMA) for the administration of anesthesia to a 3-yr-old boy with asthma and a large anterior mediastinal mass. Case Report A 16-kg, 31%z-yr-old boy presented to the emergency room in acute severe respiratory distress. He had a 3-yr history of asthma, treated with daily nebulized albuterol, cromalyn sodium, and intermittent steroids. On examination, he was sitting upright with biphasic stridor. Breath sounds were nearly inaudible over the entire left chest. He had no plethora of the head and neck, suggesting the absence of superior vena cava syndrome, and had a palpable right supraclavicular lymph node. A chest radiograph showed a massive mediastinal mass (Figure 11, and computed tomography demonstrated compression of the carina and left mainstem bronchus (Figure 2). He was given heliox and oxygen (FIo, = 0.30) and responded with both symptomatic improvement and an increase of his oxygen saturation from 76% to 96%. Because of his history of steroid-dependent asthma, and because of the significant symptoms from the mediastinal mass, he was given 1 mg/kg of intravenous prednisone. After premeditation with a total of 1.5 mg of midazolam (titrated in 0.25- to 0.5-mg increments to achieve a calm yet awake state), he was taken to the operating room where anesthesia was induced in a sitting position with slowly

Total pinealectomy by an occipital parasagittal approach in sheep

A reliable method of total pinealectomy in sheep without a resulting significant neurological deficit has been developed and is described. The known effect of light on sheep gonadotropin levels helps validate these studies of its pineal gland. Special attention is given to delineation of the surgical anatomy of the gland and its relationship under magnification to the central draining veins of the brain. In this large mammal this relationship differs considerably from that of humans. The application of an intrahemispheric occipital exposure using magnification, as well as the preoperative administration of steroids and osmotic agents, helped to minimize the effects of retraction and resultant cerebral edema. We have thus been able to increase the rate of successful pinealectomy to 83%, allowing the development of groups of animals suitable for studies of the neuroendocrine function of the pineal and pituitary glands.

CUSHING'S SYNDROME IN INFANCY

Cushing's syndrome in infancy is usually due to adrenal tumor which is often malignant. Three cases are described in which the disorder was due to adenoma and surgical cure was achieved. The clinical picture is strongly suggestive if not diagnostic. Its hallmark is generalized obesity with typical facies; also present are hypertension and signs of virilization. Striae were not found in our patients. Increased excretion of both 17-hydroxysteroids and 17-ketosteroids is characteristic; this excretion was not suppressed by dexamethasone in two of these patients in whom it was tested. Intravenous pyelogram was distinctly abnormal in all cases and indicated the presence and location of the tumor. The diagnosis can be made efficiently and surgical treatment can be promptly instituted with reasonable expectation of cure. Careful attention must be paid to preoperative and postoperative administration of adrenal steroids.