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Related Experiment Videos

Perioperative stress-dose steroids.

Kristin N Kelly1, Bastian Domajnko2

  • 1Department of Surgery, University of Rochester Medical Center, Rochester, New York.

Clinics in Colon and Rectal Surgery
|January 18, 2014
PubMed
Summary
This summary is machine-generated.

Patients on long-term steroid therapy do not need high-dose perioperative corticosteroids. Maintaining their baseline dose is sufficient, as evidence suggests supraphysiologic doses are unnecessary for surgical procedures.

Keywords:
adrenal insufficiencycorticosteroidsperioperative steroidsstress-dose steroids

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Area of Science:

  • Anesthesiology
  • Endocrinology
  • Surgical Care

Background:

  • Perioperative corticosteroid supplementation has been standard practice for patients on long-term steroid therapy for over 60 years.
  • Emerging evidence challenges the necessity of supraphysiologic corticosteroid doses in this patient population.
  • Current guidelines are based on historical practices rather than robust clinical data.

Purpose of the Study:

  • To evaluate the necessity of supraphysiologic corticosteroid doses during the perioperative period for patients on long-term steroid therapy.
  • To determine if standard maintenance doses are adequate, thereby reducing potential corticosteroid-related complications.
  • To inform clinical practice regarding corticosteroid management in surgical patients.

Main Methods:

  • Systematic review of existing literature, including retrospective studies, prospective cohorts, and randomized controlled trials.
  • Analysis of data from two small prospective, randomized placebo-controlled trials.
  • Inclusion of findings from a prospective primate trial and several systematic reviews.

Main Results:

  • Accumulating data suggests that supraphysiologic perioperative corticosteroid doses are not required for patients on long-term exogenous steroid therapy.
  • Patients can safely remain on their established baseline maintenance corticosteroid dose.
  • Secondary adrenal insufficiency should be considered as a potential cause of unexplained perioperative hypotension.

Conclusions:

  • The practice of administering supraphysiologic corticosteroid doses perioperatively is not supported by current evidence.
  • Patients on long-term steroid therapy should continue their maintenance dose, with vigilance for adrenal insufficiency.
  • Clinical guidelines should be updated to reflect the evidence against routine high-dose perioperative corticosteroid administration.