Surgical Steroid Replacement

Shaw brings the topic to another level when he states that, given the evidence we have today, it is still prudent to consider perioperative steroid coverage.22 The benefit—avoiding life-threatening adrenal insufficiency—outweighs the risk of enhanced catabolism and immunosuppression, especially if the steroid coverage is physiologic and of a very short duration.

Perioperative Glucocorticoid Coverage

Current recommendations for steroid coverage take into account the normal physiologic response to routine surgery. The idea is to mimic the transient increase in cortisol levels during the surgical and postoperative period but not to exceed the levels or the duration of the physiologic response. Doses above the physiologic ranges offer no particular benefit in routine surgical stress.5

Most of the current recommendations stem from those proposed by Salem and colleagues in 1994.5

Conclusion

For almost 50 years after it was first recognized, the need for steroid replacement in surgical situations had been addressed with high doses that created new problems in the forms of poor tissue healing and immunosuppression, causing a major dilemma in the surgical world. Now, with a more conservative and physiologic approach, the adverse consequences of glucocorticoid supplementation can be minimized and perhaps even prevented. TH

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