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Steroids in anesthesia
While the minimum dose for steroid-induced bone loss is unknown, reduced bone density and fractures have occurred with doses as low as 5mg of prednisone per day, although this range has not been well described.5,9 Although the clinical effect of steroid treatment can be minimized by taking prednisone as a single dose or in two or three daily doses, there are instances of longterm bone loss from prolonged treatment, which may be clinically significant.11 In our studies, patients had received treatment for at least three years and all patients had lost significant amounts of bone, including near or above 25% and more than 50% of the total bone mass. A number of studies have examined whether prednisone is a safe drug for treating diabetes mellitus, surgery dose before prednisone.13 For example, when we compared prednisone and insulin to patients with diabetic ketoacidosis, patients receiving prednisone had longer periods of hypoglycemia than those receiving insulin, both within and between periods of hypoglycemic episodes, although there were no differences in the type or rate of hypoglycemia, or in the clinical course of the hypoglycemia, surgery dose before prednisone.8 Similarly, in a study of diabetes patients treated with prednisone and those treated with insulin, we did not observe any differences in the clinical course, surgery dose before prednisone.7 However, in a recent study of patients with type 2 diabetes, patients receiving prednisone had greater weight loss than insulin, and weight loss was associated with a higher incidence of diabetes complications, surgery dose before prednisone.4 Since the initial reports of the potential adverse effects of prednisone in patients with type 2 diabetes,7-10 we would suggest caution when prescribing prednisone for treatment of diabetes mellitus, prednisone dose before surgery.11,12 However, based on the results of our studies of the effects of oral prednisone on insulin sensitivity and bone metabolism in patients with type 2 diabetes mellitus, it appears that patients with diabetes mellitus may be adequately protected against possible complications with oral prednisone use, prednisone dose before surgery.
Prednisone and general anesthesia
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