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Stress Dose Steroids: Myths and Perioperative Medicine

  • Surgery and Perioperative Care (CR MacKenzie and SM Goodman, Section Editors)
  • Published:
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Abstract

Perioperative medication management for patients with systemic autoimmune inflammatory diseases has focused on strategies to improve outcomes and mitigate risks. The emphasis has been to minimize the risk of infection associated with most antirheumatic medications, while attempting to avoid flares of disease precipitated by medication withdrawal. Management of glucocorticoids in the perioperative period has been based on an assumption that supraphysiologic increases in dose were always necessary to avoid hypotension and shock in glucocorticoid treated patients, and alternative strategies were rarely considered despite the known infectious, metabolic, and wound healing risks associated with glucocorticoid administration. This paper will review current recommendations for perioperative glucocorticoid administration for glucocorticoid treated patients with systemic inflammatory autoimmune diseases and discuss glucocorticoid physiology to analyze the basis for these recommendations and consider alternative perioperative management strategies.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Authors and Affiliations

  1. Department of Rheumatology, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY, USA

    C. Ronald MacKenzie & Susan M. Goodman

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  1. C. Ronald MacKenzie
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  2. Susan M. Goodman
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Correspondence to C. Ronald MacKenzie.

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CRM and SMG declare that they have no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Surgery and Perioperative Care

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MacKenzie, C.R., Goodman, S.M. Stress Dose Steroids: Myths and Perioperative Medicine. Curr Rheumatol Rep 18, 47 (2016). https://doi.org/10.1007/s11926-016-0595-7

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  • DOI: https://doi.org/10.1007/s11926-016-0595-7

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