title: Stress Dose Steroids: Myths and Perioperative Medicine.
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.
authors.affiliation: Department of Rheumatology, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY, USA. MackenzieR@HSS.edu.
authors.forename: C Ronald
authors.initials: CR
authors.lastname: MacKenzie
authors.affiliation: Department of Rheumatology, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Goodman
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D019990:Perioperative Care; D012216:Rheumatic Diseases / Q000188:drug therapy*
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids
keywords: Adrenal suppression; Glucocorticoids; Perioperative management; Stress dose steroids; Systemic autoimmune inflammatory diseases