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Tue Aug 8 07:19:18 BST 2006

Can he quote any data to support this? I'd be even more concerned about
doing it for tonsills (which are presumably routine) than for traumatic
optic neuritis which is at least reasonably rare!

Cheers, Ian

>>> "James S. Anderson" <jsandersonmdelp at sbcglobal.net> 7/08/2006
2:36pm >>>
Yes, one of our ENT surgeons requests 1 mg/kg for tonsillectomy
patients.

Steve

-----Original Message-----
From: ccm-l-bounces at ccm-l.org [mailto:ccm-l-bounces at ccm-l.org] On
Behalf Of
Ian Seppelt
Sent: Sunday, August 06, 2006 10:34 PM
To: KMATTOX at aol.com; lb86 at columbia.edu; trauma-list at trauma.org 
Cc: ccm-l at ccm-l.org 
Subject: ccml Re: Another article favoring steroids

More steroids ..... I work with a SUPERB oral maxillofacial surgeon
who
has a religious belief in the value of ridiculously high doses of
steroids to treat presumed or suspected traumatic optic neuropathy. By
"ridiculous" I mean 1-2 mg/kg (yes, per kg) of dexamethasone. 

Has anybody else come across this practice? The only literature I have
been able to find is case reports.

Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Clinical Lecturer, University of Sydney

>>> "Louis Brusco Jr., M.D." <lb86 at columbia.edu> 6/08/2006 6:40am >>>
KMATTOX at aol.com wrote:

> In a message dated 8/5/2006 1:08:01 P.M. Central Standard Time, 
> aliolios at gmail.com writes:
>
>     We are talking about steroids in sepsis/ARDS
>
> Not me.   I recognize the hazards and the downstream bad effects of 
> steroids.   I have been burned far more times than I have been 
> impressed with the therapeutic use of steroids in non-Addisonian
patients.
>  
> k

Yesterday I gave anesthesia to an AIDS patient with a mandible 
fracture.  The Oral Surgeons routinely give Dexamethasone 10 mg to all

these patients for "swelling".  The new Oral Surg chief resident, who
we 
know very well because all the Oral Surgery residents spend 4 months 
with us doing anesthesia, asked me my feelings on giving the patient 
steroids.  I asked her why she wanted the dexamethasone - she said 
because of "swelling".  I asked if it were really, really necessary.  
she said, well, no.  I said - then don't give them..not just for this 
patient - but ever!  That was a tough concept for her to grasp...I
have

no idea why - we did not give this patient the dexamethasone, but, I
am

sure, the next one will get it....

Lou

-- 
Louis Brusco Jr., M.D., F.C.C.M.
Associate Medical Director
St. Luke's-Roosevelt Hospital Center
NYC

Co-Director, Surgical Intensive Care Unit
Director, Critical Care Anesthesiology
Medical Director, Post-Anesthesia Care Unit

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ccml Re: Another article favoring steroids