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Kwon Hui Seo1

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Patients on steroid therapy require perioperative glucocorticoid supplementation to prevent adrenal crisis during surgery. Stress-dose steroids are crucial for managing surgical stress and ensuring hemodynamic stability in these patients.

Keywords:
Adrenal insufficiencyGlucocorticoidsHypothalamus-pituitary-adrenal axisPerioperative periodSteroid

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Area of Science:

  • Anesthesiology
  • Endocrinology
  • Pharmacology

Background:

  • Glucocorticoids are potent anti-inflammatory and immunosuppressive drugs used for various conditions.
  • Increasing numbers of patients on long-term steroid therapy require surgical intervention.
  • Perioperative steroid supplementation is critical for patients on glucocorticoid therapy to prevent adrenal insufficiency and crisis.

Purpose of the Study:

  • To review the necessity and guidelines for perioperative glucocorticoid supplementation in patients undergoing surgery.
  • To discuss the physiological rationale for stress-dose glucocorticoid administration.
  • To highlight the importance of individualized steroid dosing based on surgical stress and HPA axis inhibition.

Main Methods:

  • Literature review of current textbooks and research articles on perioperative glucocorticoid use.
  • Analysis of the physiological stress response and cortisol requirements during surgery.
  • Evaluation of recommended stress-doses of glucocorticoids, often cited as equivalent to 100 mg of cortisol for major surgery.

Main Results:

  • Perioperative stress-dose glucocorticoid administration is recommended to manage increased cortisol demands during surgery.
  • Failure of endogenous cortisol secretion to meet surgical stress can lead to adrenal insufficiency, hemodynamic instability, and adrenal crisis.
  • Current recommendations often suggest a stress-dose equivalent to approximately 100 mg of cortisol for major surgical procedures.

Conclusions:

  • Glucocorticoid supplementation is essential for patients on steroid therapy undergoing surgery to mitigate risks associated with surgical stress.
  • Further high-powered studies are needed to refine stress-dose glucocorticoid administration protocols.
  • Individualized assessment of surgical invasiveness and hypothalamic-pituitary-adrenal axis inhibition is key to optimizing patient outcomes and prognosis.