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Clin Colon Rectal Surg 2013; 26(03): 163-167
DOI: 10.1055/s-0033-1351132
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perioperative Stress-Dose Steroids

Kristin N. Kelly
1   Department of Surgery, University of Rochester Medical Center, Rochester, New York
,
Bastian Domajnko
1   Department of Surgery, University of Rochester Medical Center, Rochester, New York
2   Rochester Colon & Rectal Surgeons, P.C., Rochester, New York
› Author Affiliations
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Publication History

Publication Date:
19 August 2013 (online)

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Abstract

Supraphysiologic corticosteroid doses have routinely been considered the perioperative standard of care over the past six decades for patients on long-term steroid therapy. However, the accumulation of data over this period is beginning to suggest that such a practice may not be necessary. The majority of these studies are retrospective reviews or small prospective cohorts, but there are two small prospective, randomized placebo-controlled trials, one prospective primate trial, and several systematic reviews addressing the issue. Based on this developing evidence, patients on long-term exogenous steroids do not require high-dose perioperative corticosteroids and should instead remain on their baseline maintenance dose, with the understanding that secondary adrenal insufficiency should be considered for unexplained perioperative hypotension in these patients.

Keywords

stress-dose steroids - adrenal insufficiency - corticosteroids - perioperative steroids
 

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