Perioperative “stress dose” of corticosteroid: Pharmacological and clinical perspective

Abstract

Various exogenous steroid preparations have been in use for a wide range of indications. We, as an anesthesiologist often encounters a surgical patient receiving chronic steroid therapy. Perioperative use of steroid is associated with major complications such as full-blown adrenal crisis in the perioperative period due to the secondary adrenal insufficiency. Henceforth, comes the role of the perioperative “stress-dose” of steroids to mitigate this rare but potentially fatal complication. There have been opposing views regarding the need and the appropriate dosage of the perioperative steroids. The present review discusses the changing concept of perioperative “stress dose” of corticosteroids, its pharmacokinetics, clinical relevance, and the related controversies such as the need and the appropriate dose.

Corticosteroid-induced sinus bradycardia in a young boy with adrenal insufficiency and sepsis

“…Furthermore, cardiac monitoring and slow rates of infusion should be considered. 10 The Naranjo scale is a tool used to assess the probability of an adverse drug event and determine causality, and it has scores between 0 and 13. In our case, given the suspicion of an adverse drug reaction to hydrocortisone, we calculated the score as 8, which indicates a probable causality.…”

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

“…Hydrocortisone is the drug of choice for stress and rescue dose steroid coverage [ 168 ]. Growing body of data suggests administration of dexamethasone instead, having no mineralocorticoid activity and probably the same protective effect in short course.…”

Bradicardia sinusal inducida por corticoesteroides en un niño con insuficiencia suprarrenal y septicemia

“…Además, deben considerarse el monitoreo cardíaco y una velocidad de infusión lenta. 10 La escala de Naranjo es una herramienta para evaluar la probabilidad de que ocurra una reacción adversa a un medicamento y determinar la causalidad, con un puntaje de 0 a 13. En nuestro caso, dada la sospecha de una reacción adversa a la hidrocortisona, el puntaje calculado fue 8, lo que indica causalidad probable.…”