Corticosteroids and anesthesia

For decades, anesthesiologists and surgeons have prophylactically provided 'stress steroids' to patients with presumed adrenocortical suppression. Other indications for glucocorticoids have included the suppression of cerebral or airway edema, the inhibition of systemic inflammatory responses to cardiopulmonary bypass, and the treatment of shock states possibly associated with adrenocortical insufficiency. Some recent studies have either restated or challenged the conventional supraphysiological doses of 'stress steroids', while others have investigated the efficacy of glucocorticoids in improving various aspects of postoperative recovery.

In 2001, Jabbour summarized the normative rationale and dose regimen for stress-dose steroids in patients who have been receiving corticosteroids. A few months later, Brown and Buie concluded from their literature review that such patients can be safely managed with only physiologic or maintenance glucocorticoid administration. A torrent of reports on the antiemetic effects of dexamethasone generally indicate that this drug does reduce the incidence of postoperative nausea and vomiting, with somewhat delayed but prolonged efficacy, and acts synergistically with 5-HT3 receptor antagonists. Other authors have studied the administration of corticosteroids to patients undergoing major abdominal and other operations, and have found beneficial effects on various complications.

While the conventional practice concerning 'stress steroids' is probably harmless and possibly beneficial, similar benefits might be seen with lower prophylactic doses. Alternatively, new uses for these old agents are arising, and may enable us to improve the convalescence of larger numbers of our patients.