25: Should stress-dose steroids be given?

In this episode, Dr. Jonathan Charnin and Dr. Daniel Saddawi-Konefka join us to explore the evidence around perioperative stress dose steroids and adrenal insufficiency. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. -- Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at [email protected] with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. -- References Axelrod L. Perioperative management of patients treated with glucocorticoids. Endocrinol Metab Clin North Am. 2003 Jun;32(2):367-83. doi: 10.1016/s0889-8529(03)00008-2. PMID: 12800537. Bromberg JS, Baliga P, Cofer JB, et al. Stress steroids are not required for patients receiving a renal allograft and undergoing operation. J Am Coll Surg 1995;180:532–536. Christy NP. Corticosteroid withdrawal. In: Current Therapy in Endocrinology and Metabolism, 3rd Ed, Bardin CW (Ed), BC Decker, New York 1988. P.113. Glowniak JV, Loriaux DL. A double-blind study of perioperative steroid requirements in secondary adrenal insufficiency. Surgery. 1997 Feb;121(2):123-9. doi: 10.1016/s0039-6060(97)90280-4. PMID: 9037222. Kehlet H, Binder C. Adrenocortical function and clinical course during and after surgery in unsupplemented glucocorticoid-treated patients. Br J Anaesth. 1973 Oct;45(10):1043-8. doi: 10.1093/bja/45.10.1043. PMID: 4772640. LEWIS L, ROBINSON RF, YEE J, HACKER LA, EISEN G. Fatal adrenal cortical insufficiency precipitated by surgery during prolonged continuous cortisone treatment. Ann Intern Med. 1953 Jul;39(1):116-26. doi: 10.7326/0003-4819-39-1-116. PMID: 13065993. Melanie M. Liu, Andrea B. Reidy, Siavosh Saatee, Charles D. Collard; Perioperative Steroid Management: Approaches Based on Current Evidence. Anesthesiology 2017; 127:166–172 doi: https://doi.org/10.1097/ALN.0000000000001659 Prete A, Yan Q, Al-Tarrah K, Akturk HK, Prokop LJ, Alahdab F, Foster MA, Lord JM, Karavitaki N, Wass JA, Murad MH, Arlt W, Bancos I. The cortisol stress response induced by surgery: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018 Nov;89(5):554-567. doi: 10.1111/cen.13820. Epub 2018 Aug 23. PMID: 30047158. Rushworth RL, Torpy DJ, Falhammar H. Adrenal Crisis. N Engl J Med. 2019 Aug 29;381(9):852-861. doi: 10.1056/NEJMra1807486. PMID: 31461595. Salem M, Tainsh RE Jr, Bromberg J, Loriaux DL, Chernow B. Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem. Ann Surg. 1994;219(4):416-425. doi:10.1097/00000658-199404000-00013 Thomason JM, Girdler NM, Kendall-Taylor P, Wastell H, Weddel A, Seymour RA. An investigation into the need for supplementary steroids in organ transplant patients undergoing gingival surgery. A double-blind, split-mouth, cross-over study. J Clin Periodontol. 1999 Sep;26(9):577-82. doi: 10.1034/j.1600-051x.1999.260903.x. PMID: 10487307. Woodcock T, Barker P, Daniel S, Fletcher S, Wass JAH, Tomlinson JW, Misra U, Dattani M, Arlt W, Vercueil A. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK. Anaesthesia. 2020 May;75(5):654-663. doi: 10.1111/anae.14963. Epub 2020 Feb 3. Erratum in: Anaesthesia. 2020 Sep;75(9):1252. PMID: 32017012. Zaghiyan K, Melmed G, Murrell Z, Fleshner P. Are high-dose perioperative steroids necessary in patients undergoing colorectal surgery treated with steroid therapy within the past 12 months? Am Surg. 2011 Oct;77(10):1295-9. PMID: 22127073.