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Steroids in oral and maxillo facial surgery PowerPoint Presentation

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Description : ROLE OF Steroids in oral and maxillo facial surgery

Tags : Steroids in oral,maxillo facial surgery,facial surgery,surgery

Published on : Sep 14, 2021 | Views : 2187 | Downloads : 4

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Slide 1-

Role of Steroids in oral and maxillo facial surgery
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Steroids are the boon to medical field Steroids are double-edged sword Steroids are very controversial life saving drugs Hench and kendall in 1949 first reported the effectiveness of glucocorticosteroids as anti-inflammatory agent Noble prize in 1950
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physiology secretion - cortex of adrenal gland average cortisol sec 15-20 mg/day shows circadian rhythm Carriage 90% plasma cortisol bound to protein 10% -free-physiologically active average plasma cortisol conc-12ug/dl
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stress Higher centers of brain hypothalamus CRF Anterior pituitary (stimulated) ACTH Adrenal cortex (stimulated) Endogenous cortisol
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Relative activity of systemic corticosteroids
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Absolute contraindications Active healed or incompletely healed tuberculosis Ocular herpes simplex Primary glaucoma Acute psychosis allergy
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Relative contraindications Diverticulitis Recent intestinal anastomosis Active or latent peptic ulcer disease Cushings syndrome Renal insuffiency Hypertension Thromboembolic tendencies or thrombophlebitis Osteoporosis Diabetes mellitus Myasthenia gravis Psychotic tendencies Acute or chronic infections first trimester of pregnancy
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Potential side effects of corticosteroids Suppression of bodily defense mechanisms with diminished resistance to infections Hypertension Hyperglycemia Hypochloremic- hyperkalemic alkalosis Perforation of gastro intestinal ulcers Amenorrhea Hirsutism Acne Psychosis with euphoria and mental instability Ecchymosis Osteopenia Glaucoma Insomnia Increased appetite Allergic reactions
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General principles of steroid therapy (JIAMOR, jun 1997) Steroids are not curative and hence should be sparingly used Steroids have many adverse reactions Almost any disease may show some symptomatic relief on initiation of therapy due to its excellent anti inflammatory properties Use of steroids incorrectly can backfire due to adverse reactions
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When steroids use is indicated; topical steroids is safer than intra lesional steroids is safer than systemic steroids Dose should be minimum possible to ensure remission Doses should be tapered gradually to permissible dose before discontinuing therapy Single large early morning dose is the safest Intermediate acting compounds (prednisolone,etc) are preferable to long acting compounds (betamethasone,etc), the former can be used in alternate day therapy
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Although best avoided in pregnancy, prednisolone is the safest as it is deactivated by the placenta. Therapy is given in the morning on alternate days Patients treated by oral physicians by steroid therapy where HHPA may be suppressed, must be given a card detailing entire schedule of therapy. Patient must be asked to inform the doctor before any surgical procedure including routine dental check up during the corresponding period
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Therapeutic regimens Short term and pulse therapy(JOMS,1990) Short term -- high dose therapy 48-72 hrs intense steroid administration Pulse therapy--Single IV injection suprapharmacologic dose of steroid i.e 0.5 - 2 gms of prednisolone or its equivalent Gersema and Baker (JOMS,1992) IV or IM methyl prednisolone 125 mg before 3rd molar surgery Weber and Griffin (JOMS,1994) Single 16 mg IV dose of dexamethasone pre op
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Therapeutic regimens Daniel M Laskin (OMFSCNA,2001) For long orthognathic surgeries 8 mg dexamethasone pre operatively 8 mg every 4 hrs during procedure 8 mg IV every 8 hours during 1st 24 hours Short cases 8 mg dexamethasone at beginning and again at the end of surgery 8 mg every 8 hours during first 24 post operative hours Messer and Killer (JOS,1975) Use of dexamethasone 4mg injected into masseter muscle in completion of extraction of 3rd molar
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Management of patient with a history of systemic corticosteroids
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stress Higher centers of brain hypothalamus CRF Anterior pituitary (stimulated) ACTH Adrenal cortex (stimulated) Acute insufficiency Exogenous cortisol
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Management of adrenal insufficiency conscious patients terminate dental care Position patient –comfortably, if asymptomatic;supine with feet elevated,if symptomatic monitor vital signs summon medical assistance obtain emergency kit and oxygen Administer glucocorticosteroid,if available,and if h/o adrenal insufficiency Additional management: provide basic life support,as needed;provide oxygen as needed ;provide corticosteriods,as needed Establish IV line
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Unconscious patient Recognize unconsciousness Position patient in supine position with feet elevated provide basic life support ,as needed provide definitive managament obtain emergency kit and oxygen summon medical assistance evaluate medical history administer corticosteroid establish IV line , if possible transfer to hospital
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Functions of steroids metabolic