title: High-dose perioperative corticosteroids in steroid-treated patients undergoing major colorectal surgery: necessary or overkill?
abstract: BACKGROUND
  Steroid-treated patients undergoing major colorectal surgery are routinely treated with high-dose steroids (HDS) to prevent perioperative adrenal insufficiency and cardiovascular collapse. However, there is no evidence to support this practice.
  
  
  METHODS
  A retrospective analysis of 97 consecutive steroid-treated patients with inflammatory bowel disease who underwent major colorectal surgery was performed. The incidence of hemodynamic instability and surgical outcomes were compared in patients treated with perioperative low-dose steroids (LDS) versus HDS.
  
  
  RESULTS
  Forty-three patients were treated with HDS, and 54 patients received LDS. There was no significant difference in hemodynamic instability between HDS-treated (74%) and LDS-treated (78%) patients. No patients required rescue HDS for adrenal insufficiency.
  
  
  CONCLUSIONS
  Steroid-treated patients with inflammatory bowel disease undergoing major colorectal surgery appear to have no clinically significant hemodynamic instability when managed with LDS versus HDS. A prospective study assessing perioperative steroid dosing in patients with inflammatory bowel disease is in progress.
authors: Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: Karen N
authors: KN
authors: Zaghiyan
authors: Zuri
authors: Z
authors: Murrell
authors: Gil Y
authors: GY
authors: Melmed
authors: Phillip R
authors: PR
authors: Fleshner
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000309:Adrenal Insufficiency / Q000150:complications* / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones