Anesthetic implications for patients receiving exogenous corticosteroids

Opposing views exist about perioperative replacement of corticosteroids and appropriate replacement dosages. Anesthesia providers must be aware of the need for corticosteroid replacement not only in patients who have primary adrenal insufficiency but also in patients who have adrenal insufficiency resulting from long-term corticosteroid therapy. Without adequate knowledge, the anesthesia provider may fail to prepare the patient to withstand the stress of surgery and may open the way for life-threatening hemodynamic abnormalities that accompany inadequate amounts of corticosteroids. The purpose of this article is to review the literature explaining the rationale and the proper perioperative dosing with corticosteroids for patients with long-standing asthma, rheumatoid arthritis, or Crohn disease. The review of literature reflects articles on endogenous hormones, exogenous hormones, diseases that require long-term corticosteroid therapy, the hypothalamus-pituitary-adrenal axis, and corticosteroid replacement therapy.