Hypotension During and After Operation in Glucocorticoid-Treated Patients

Knudsen, L.; Christiansen, Leif; Lorentzen, Jørgen

doi:10.1093/bja/53.3.295

Cited by 28 publications

(10 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It should be noted that the aforementioned studies used a SBP <80 mmHg criterion [8] in the diagnosis of hypotension. We have demonstrated this criterion, as well as the previously published SBP criteria of 90 and 100 mmHg [1][2][3][4][5][6][7], to be of low sensitivity for this purpose. As such, it is the authors' contention that clinicians using these criteria may be underestimating the incidence of hypotension during hemapheresis.…”

Section: Hypotensive Episodes and The Incidence Of Hemapheresis-relatmentioning

confidence: 68%

“…Thus, discussion of SBP cutoffs is merited at this point. As mentioned previously, the current literature routinely defines hypotension (objectively) as SBP less than 80, 90, or 100 mmHg [1][2][3][4][5][6][7][8][9][10][11]46]. We have indicated here and previously [11] that these criteria, although highly specific, are not sensitive in the routine detection of hypotension.…”

Section: Sbp Cutoff Valuesmentioning

confidence: 71%

“…While hypotension is not an uncommon phenomenon in patients undergoing hemapheresis procedures and presents as diverse clinical manifestations, the literature provides no single widely accepted threshold pressure for its diagnosis. The use of absolute systolic blood pressure (SBP) threshold values (ranging anywhere from 80 to 100 mmHg) are advocated by some, while others contend that a drop in SBP from the baseline of 25 to 30%, or an absolute drop of 30 mmHg, signifies hypotension [1][2][3][4][5][6][7][8][9][10]. The most widely published threshold is the SBP <80 mmHg criterion [8], with few utilizing mean arterial pressure (MAP)-based criteria.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mean arterial pressure and systolic blood pressure for detection of hypotension during hemapheresis: Implications for patients with baseline hypertension

et al. 2005

View full text Add to dashboard Cite

Mean arterial pressure (MAP) has been characterized as a more sensitive and physiologically appropriate hemodynamic parameter in the detection of hemapheresis-related hypotension, resulting in a much closer correlation with the presence of symptomatic hypotension. Patients were enrolled over a 12-month period and data collected on any previous diagnosis of hypertension, antihypertensive therapy used, indication for apheresis, age decile, and gender. Baseline vital signs, any hypotensive signs or symptoms observed, and the patient's vital signs at the time of any hypotensive episode were recorded. Patients were assigned to a subgroup, sensitivity and specificity analysis performed, positive likelihood ratios calculated, receiver operating characteristic curves constructed, and ideal cutoff values identified. The incidence of hypotension among our study population was found to be 6.8%. Over all procedures, systolic blood pressure (SBP) was determined to be a "poor" test for detecting hypotension, while MAP demonstrated a "fair" capacity. A downward normalization was evident in the ideal cutoff value based upon a patient's hypertensive history. The currently accepted SBP less than 80 mmHg cutoff failed to detect hypotensive episodes among baseline hypertensive patients, raising questions about its sensitivity. Based upon physiologic principles and study findings, a MAP-based criterion is preferable in the diagnosis of hypotension during hemapheresis.

show abstract

Section: Hypotensive Episodes and The Incidence Of Hemapheresis-relatmentioning

confidence: 68%

Section: Sbp Cutoff Valuesmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mean arterial pressure and systolic blood pressure for detection of hypotension during hemapheresis: Implications for patients with baseline hypertension

et al. 2005

View full text Add to dashboard Cite

show abstract

“…73 Zaghiyan et al conducted a randomized trial investigating the use of the high-dose (IV hydrocortisone 100 mg 3 times daily, followed by taper) versus low-dose (IV hydrocortisone equivalent to preoperative dosing or no corticosteroid dosing for patients who were not taking steroids at the time of surgery) perioperative corticosteroids for 92 corticosteroid-treated patients with IBD undergoing colorectal surgery. Knudsen et al reported perioperative outcomes for 95 patients with IBD who underwent 250 operations during an 11-year study period.…”

Section: Perioperative Management Of Steroid-exposed Patientsmentioning

confidence: 99%

Perioperative Corticosteroid Management for Patients with Inflammatory Bowel Disease

Hicks

Wick

Salvatori

et al. 2015

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

Guidelines on the appropriate use of perioperative steroids in patients with inflammatory bowel disease (IBD) are lacking. As a result, corticosteroid supplementation during and after colorectal surgery procedures has been shown to be highly variable. A clearer understanding of the indications for perioperative corticosteroid administration relative to preoperative corticosteroid dosing and duration of therapy is essential. In this review, we outline the basic tenets of the hypothalamic-pituitary-adrenal (HPA) axis and its normal response to stress, describe how corticosteroid use is thought to affect this system, and provide an overview of the currently available data on perioperative corticosteroid supplementation including the limited evidence pertaining to patients with inflammatory bowel disease. Based on currently existing data, we define "adrenal suppression," and propose a patient-based approach to perioperative corticosteroid management in the inflammatory bowel disease population based on an individual's historical use of corticosteroids, the type of surgery they are undergoing, and HPA axis testing when applicable. Patients without adrenal suppression (<5 mg prednisone per day) do not require extra corticosteroid supplementation in the perioperative period; patients with adrenal suppression (>20 mg prednisone per day) should be treated with additional perioperative corticosteroid coverage above their baseline home regimen; and patients with unclear HPA axis function (>5 and <20 mg prednisone per day) should undergo preoperative HPA axis testing to determine the best management practices. The proposed management algorithm attempts to balance the risks of adrenal insufficiency and immunosuppression.

show abstract

“…7,11 It is well established that patients with documented suppression of adrenal function can undergo surgical treatment without event. 27 Glowniak and Loriaux 28 conducted a double blind study of 18 patients with proven HPA suppression undergoing moderate to major surgery. The test group received supplementation of 200 mg cortisol for the first 24 hours followed by 100 mg the second day and 50 mg the third day, while the control group received only their regular steroid dose.…”

Section: Exogenous Glucocorticoids and Adrenal Suppressionmentioning

confidence: 99%

Steroid cover for dental patients on long-term steroid medication: proposed clinical guidelines based upon a critical review of the literature

Gibson

Ferguson

2004

Br Dent J

View full text Add to dashboard Cite

Based to a great extent upon mainly anecdotal case reports and theory, there is a general acceptance that patients on longterm systemic steroid medication should receive supplementary glucocorticoids or 'steroid cover' when undergoing certain types of stressful treatment including dentistry. The theoretical basis to this practice is that exogenous steroids suppress adrenal function to an extent that insufficient levels of cortisol can be produced in response to stress, posing the risk of acute adrenal crisis with hypotension and collapse. The purpose of this paper is to review relevant literature and propose clinical guidelines for dental practitioners. Of numerous reported cases of adrenal crisis following procedural interventions, few stand up to critical evaluation. Other reviewers have reached similar conclusions. A number of studies confirm the low likelihood of significant adrenal insufficiency even following major surgical procedures. Various authors have suggested modified guidelines for management of patients on steroid medications. Patients on long-term steroid medication do not require supplementary 'steroid cover' for routine dentistry, including minor surgical procedures, under local anaesthesia. Patients undergoing general anaesthesia for surgical procedures may require supplementary steroids dependent upon the dose of steroid and duration of treatment.

show abstract

Hypotension During and After Operation in Glucocorticoid-Treated Patients

Cited by 28 publications

References 8 publications

Mean arterial pressure and systolic blood pressure for detection of hypotension during hemapheresis: Implications for patients with baseline hypertension

Mean arterial pressure and systolic blood pressure for detection of hypotension during hemapheresis: Implications for patients with baseline hypertension

Perioperative Corticosteroid Management for Patients with Inflammatory Bowel Disease

Steroid cover for dental patients on long-term steroid medication: proposed clinical guidelines based upon a critical review of the literature

Contact Info

Product

Resources

About