A lady had Meningioma with inflammatory edematous lesion. She was planned for surgery. Junior resident's mistake in writing pre-op notes is:
Ans is 'a' i.e. Stop steroids There is no rationale to stop the steroids preoperatively. Sudden withdrawal of steroids may lead to adrenal insufficiency, paicularly during period of stress such as surgery. The management of patients taking glucocoicoids preoperatively: In general, the duration of use and dosing of glucocoicoids determines appropriate management: Patients who have taken glucocoicoids for less than three weeks, or who have taken chronic alternate day therapy, are unlikely to have a suppressed hypothalamic-pituitary-adrenal (HPA) axis and should continue usual doses of glucocoicoids perioperatively. Patients taking prednisone at a dose greater than 20 mg/day for three weeks or more, and patients with a Cushingoid appearance should be assumed to have HPA axis suppression and may need an increased dose of coicosteroids perioperatively. (However several studies have a different view that the patients on chronic steroid could continue on their usual daily dose of glucocoticoids perioperatively)
Stop Steroids
Wash head with shampoo
Antibiotic Sensitivity
Continue antiepileptics