Steroids in spinal cord injury ?

[Ivan Hronek]

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I got an approval from Sandy Miller to post this here, anyone feels strongly about it ?



At the PGA (Postgraduate Assembly of the NYSSA)last December, the 
question came up in a discussion during a panel (I missed the main 
talk because of another meeting).

This is for those who deal with acute spinal cord injured patients. 
The question asked was: given a patient who is both head and spinal 
cord injured,would you use megadose steroids? To my surprise--and 
shock--the panelist answered yes. I didn't get a chance to make a 
comment myself because time was up.

Now, I had thought that it was generally understood by now that the 
evidence for any good effect of steroids in SCI is at best 
questionable, and that the evidence for harm from steroids in acute 
brain injury is unequivocable. Hence my shock. Certainly, if you have 
to be most concerned with any injury, one to the brain should be at 
the top of the list.

So, my question for the list: does anyone still use megadose steroids 
for spinal cord injured pts? If so, why? If not, why not? If you have 
a pt with SCI who also has a head injury, would you use them then? If 
so, why?

Shameful self-promotion: I have an article on this in the current 
issue of Jopurnal of Neurosurgical Anesthesiology, and just finished 
our chapter on Trauma and Burns for the next issue of Barash, so I 
have gone over the literature pretty thoroughly. I'll post some 
references if you like; I'm running out of time now.

Sanford M. Miller, MD

 
Ivan Hronek MD 
SFMC, Los Angeles
cell: 310 487-3288
http://health.groups.yahoo.com/group/Anesthideas/
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