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Curr Rheumatol Rep. 2016 Jul;18(7):47. doi: 10.1007/s11926-016-0595-7.

Stress Dose Steroids: Myths and Perioperative Medicine.

Author information

1
Department of Rheumatology, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY, USA. MackenzieR@HSS.edu.
2
Department of Rheumatology, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY, USA.

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.

KEYWORDS:

Adrenal suppression; Glucocorticoids; Perioperative management; Stress dose steroids; Systemic autoimmune inflammatory diseases

PMID:
27351679
DOI:
10.1007/s11926-016-0595-7
[Indexed for MEDLINE]

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