Q: Given if Decadron (Dexamethasone) is not available, what is the dose of Solumedrol (methylprednisolone) is appropriate to use in post-extubation stridor/risk of laryngeal edema?


Answer:    Methylprednisolone 20 mg every four hours for a total of four doses. 

Dexamethasone 4 mg for total of four doses is usually used in ICUs to avoid re-intubation secondary to laryngeal edema. Methylprednisolone can be used also instead of Dexamethasone. 20 mg of Methylprednisolone is usually enough. At the most 40 mg should be suffice. Objective of this question is to emphasize to avoid massive dose of steroid.


 Reference: 

 Cheng KC, Chen CM, Tan CK, et al. Methylprednisolone reduces the rates of postextubation stridor and reintubation associated with attenuated cytokine responses in critically ill patients. Minerva Anestesiol 2011; 77:503.