Dosage effects of pulsed steroid therapy on serum cortisol levels in oral and maxillofacial surgery patients.

The purpose of this study was to determine the effects of two dosage regimens of dexamethasone on the serum cortisol levels of a group of patients undergoing major maxillofacial surgical procedures. Analysis of the data demonstrated that the use of dexamethasone, 10 to 20 mg intravenously given every 3 hours intraoperatively and every 4 hours postoperatively over 24 hours, followed by a repository dose of 80 mg of intramuscular methylprednisolone, causes short-term serum cortisol suppression. The maximum depression occurred on postoperative day 3; normal levels were restored by postoperative day 7. Therefore, pulsed therapy can be considered relatively safe when known contraindications have been considered.