Can you use Flonase before general anesthesia?

General anesthesia involves the use of medications to induce a temporary state of unconsciousness during surgery or other medical procedures. This allows the procedure to be performed without the patient feeling pain or being aware of what is happening. Some common medications used for general anesthesia include propofol, sevoflurane, desflurane, and isoflurane.

Flonase (fluticasone) is a prescription corticosteroid nasal spray that is commonly used to treat nasal symptoms of allergies or asthma. It works by reducing inflammation in the nasal passages. Some key points about Flonase:

  • It is approved for use in adults and children 4 years and older.
  • The active drug in Flonase is fluticasone propionate.
  • It comes in a nasal spray that is sprayed into each nostril 1-2 times per day.
  • It takes several days of regular use for the full effects to occur.
  • Potential side effects include nosebleeds, headaches, and sore throat.

Is it safe to use Flonase before general anesthesia?

In most cases, it is considered safe to continue using Flonase as prescribed by your doctor before a procedure requiring general anesthesia. Here are some key points on using Flonase with anesthesia:

  • There are no known significant interactions between Flonase and the medications commonly used for general anesthesia.
  • Continuing Flonase before surgery helps prevent rebound nasal congestion and inflammation that could occur if the medication is stopped abruptly.
  • Make sure to tell your anesthesiologist about all medications you are taking, including Flonase.
  • Your doctor may recommend using a saline nasal spray instead, especially right before surgery, to minimize any bleeding risk.
  • For certain types of head and neck surgeries, your doctor may recommend stopping Flonase several days before surgery.

Overall, in most surgeries, it is considered safe to continue taking Flonase as prescribed up until the day of the procedure. But be sure to discuss this with both the surgeon and anesthesiologist.

Why continuing Flonase is usually recommended

There are a few reasons why your doctor will likely recommend continuing to take Flonase normally before general anesthesia:

  • Prevents rebound congestion – Stopping Flonase abruptly can lead to rebound swelling and congestion of the nasal passages. This could be very uncomfortable and interfere with breathing.
  • Maintains steroid coverage – Flonase needs to be taken daily to maintain its anti-inflammatory effect. Stopping it suddenly removes this protective steroid effect.
  • Avoids interactions – Fluticasone has low potential for drug interactions compared to some other nasal steroids. There are no known interactions with anesthesia meds.
  • Well-studied safety profile – Flonase has been used by millions of patients and has a well-established safety record. No links to anesthesia risks have been found.
  • Minimizes risks of stopping – Suddenly stopping Flonase could potentially pose more risks than continuing its use before routine surgeries.

Therefore, most doctors consider it better to maintain the regular dosing schedule right up until the day of surgery.

Is there any concern with bleeding risk?

One potential concern is that corticosteroid nasal sprays like Flonase could increase the risk of bleeding during or after surgery. However, for most procedures, this risk is low and manageable:

  • Flonase can disrupt normal clotting and wound healing, but systemic absorption is low with nasal administration.
  • Heavy bleeding after nasal surgery is a bigger concern, as high steroid levels are present locally.
  • Follow instructions to stop Flonase several days before any nasal or sinus surgery.
  • The anesthesiologist can use medications to help control bleeding risk during surgery.
  • Proper surgical technique helps prevent postoperative bleeding complications.

To minimize any bleeding concerns, your doctor may have you stop the nasal spray 1-2 days specifically before general anesthesia. Saline spray can be used to manage nasal symptoms instead during this brief period.

What about surgery on the nose or sinuses?

For surgery involving the nose, sinuses or mouth, your surgeon will likely recommend stopping Flonase further in advance of the procedure. This may be 5-7 days or longer before surgery.

Some examples of procedures where longer cessation of Flonase may be advised include:

  • Rhinoplasty (nose surgery)
  • Septoplasty to correct a deviated septum
  • Endoscopic sinus surgery
  • Tonsillectomy and adenoidectomy
  • Dental extractions or implants

This allows the local steroid effects to dissipate and minimizes bleeding risks during delicate surgery on these areas. Be sure to follow your doctor’s specific pre-op instructions on stopping Flonase before these types of procedures.

Key points to remember

To summarize key points on using Flonase before surgery with general anesthesia:

  • For most routine surgeries, continue Flonase as prescribed up until the day of surgery.
  • Always inform your surgeon, anesthesiologist, and nurses about Flonase use.
  • Discontinue Flonase 1-2 days before surgery if instructed to minimize bleeding risks.
  • Stop Flonase usage 5-7+ days prior for nose, sinus, or mouth surgeries.
  • Restart Flonase after surgery once any nose or sinus bleeding has resolved.
  • Let your doctors know if you have any concerns about stopping your Flonase.

With proper timing of when to stop and restart Flonase around the date of surgery, risks are low. Be sure to discuss your particular situation with your healthcare providers.

What to tell your anesthesiologist

It is important to inform the anesthesiologist and the full surgical team about all your medical history and medications. Here are some specific things to mention about Flonase use:

  • Let them know you regularly use Flonase nasal spray.
  • Inform them of the dose amount and how many sprays per day.
  • Mention how long you have been using it.
  • Confirm when you last used Flonase before coming in for surgery.
  • Disclose any nasal symptoms or congestion you are experiencing.
  • Discuss any concerns about stopping the Flonase.
  • Ask if they recommend using saline spray instead right before surgery.

Giving this information will allow the medical team to best manage your Flonase use around the time of anesthesia and surgery. Be honest and thorough when providing your medication history.

Risks and side effects

While considered generally safe, some potential risks and side effects are possible with using Flonase around surgical procedures with anesthesia. These include:

  • Rebound swelling – Abruptly stopping Flonase can cause swelling and congestion. This may be uncomfortable and interfere with breathing.
  • Bleeding – Flonase may interfere with blood clotting, raising the risk of nosebleeds or other bleeding issues.
  • Infection – Steroids may impair the body’s ability to heal or fight infection after surgery.
  • Delayed wound healing – Use of Flonase may slow down recovery and closure of surgical wounds.
  • Adverse interactions – Potential drug interactions between Flonase and anesthetic agents.

However, risks remain low in most cases with proper pre-op planning. Be sure to get instructions from your doctors on properly timing when to stop and restart Flonase around your surgery date.

Is Flonase approved for young children?

Flonase is FDA approved for use in children 4 years and older. Here is some information on Flonase use in pediatric patients undergoing anesthesia and surgery:

  • Safety and effectiveness has not been established in children under 4 years old.
  • Pre-approval pediatric trials have been conducted to study its use in children.
  • There is limited data on surgical use in children, but no safety issues identified.
  • Dosing is based on age – 1 spray per nostril once a day for children 4-11 years old.
  • The same precautions apply for stopping before nose/sinus surgery to reduce bleeding risk.
  • Discuss with the surgeon and anesthesiologist before giving Flonase to young children before surgery.

While limited, available evidence suggests Flonase can be continued before general anesthesia in children over age 4. But specialized pre-op instructions may apply, so be sure to discuss this.

Can you take Flonase after surgery?

Typically, Flonase can be resumed shortly after surgery once any nasal bleeding has subsided, including after procedures done under general anesthesia. Here are some guidelines for restarting Flonase after surgery:

  • Wait at least 1 week after any sinus or nasal surgery before restarting Flonase.
  • Discuss with your surgeon when it is safe to begin using Flonase again after your specific procedure.
  • Start back at your regular prescribed dosage unless otherwise instructed.
  • Call your doctor if any worrisome side effects occur when resuming the medication.
  • Avoid spraying Flonase directly on any nasal incision sites until fully healed.

Be patient and allow the surgical area to heal before restarting Flonase. Proper post-op use will help minimize risks like impaired wound healing. Follow all instructions from your healthcare providers.

What about other nasal steroid sprays?

The recommendations for Flonase also apply to other prescription nasal steroid sprays like:

  • Triamcinolone (Nasacort)
  • Budesonide (Rhinocort)
  • Mometasone (Nasonex)
  • Ciclesonide (Omnaris, Zetonna)

These medications all act as topical corticosteroids to reduce inflammation. The same precautions would apply for stopping usage before nasal surgeries and continuing use before other non-nose procedures.

Over-the-counter nasal sprays like Nasacort and Flonase are also options. But prescription formulations may be stronger and more effective for some people. Discuss the options with your doctor.

What about oral steroids like prednisone?

Oral steroids like prednisone are different than nasal sprays like Flonase. Here are some key points on oral steroids before surgery:

  • They have higher systemic effects compared to nasal steroids.
  • It is usually recommended to taper oral steroids several weeks before a planned surgery when possible.
  • Abruptly stopping oral steroids can cause adrenal insufficiency issues.
  • Work closely with your doctors on timing for tapering off oral steroids pre-op.
  • May receive stress dose steroids during procedures to prevent adrenal crisis.

So stricter guidelines typically apply for discontinuing systemic oral steroids versus topical nasal sprays before surgery. Have an informed discussion with your medical team.

Conclusion

In most situations, continuing Flonase nasal spray as prescribed is considered safe and recommended before surgeries requiring general anesthesia. This prevents complications like rebound swelling and disrupted steroid coverage.

However, following surgeon instructions for stopping several days before nose or sinus procedures is important to lower bleeding risks. Always inform your surgical team about Flonase use to properly manage medication timing.

With prudent precautions and smart coordination with your doctors, Flonase can typically be used right up until the day of surgery. Following proper protocols will help reduce risks and support optimal surgical outcomes.

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