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
