Peri‐operative corticosteroid supplementation for patients on therapeutic glucocorticoids: a national survey

Ramesh, Aravind; Pufulete, Maria; Reeves, Barnaby C; Fletcher, Simon; Tomlinson, Jeremy W.; Gibbison, Ben

doi:10.1111/anae.15176

Cited by 3 publications

(2 citation statements)

References 2 publications

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“…Historically, this risk has driven the practice of prescribing stress dose glucocorticoids 2 . However, there is a lack of standardization regarding peri‐operative stress dose glucocorticoids in paediatric and adult clinical practice 3,4 . The absence of agreed protocols is largely due to the limitations of existing evidence including inconsistency in patient selection, type of surgery, anaesthesia practice, measured clinical outcome and steroid dosing regimen 4 .…”

Section: Introductionmentioning

confidence: 99%

“…2 However, there is a lack of standardization regarding peri-operative stress dose glucocorticoids in paediatric and adult clinical practice. 3,4 The absence of agreed protocols is largely due to the limitations of existing evidence including inconsistency in patient selection, type of surgery, anaesthesia practice, measured clinical outcome and steroid dosing regimen. 4 While there is a growing body of literature on the use of glucocorticoids in the peri-operative management of adult patients with adrenal insufficiency, paediatric-specific data are very limited.…”

Section: Introductionmentioning

confidence: 99%

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Peri‐operative steroid management in the paediatric population

Heath

Siafarikas

Sommerfield

et al. 2021

Acta Anaesthesiol Scand

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Background Patients with adrenal insufficiency are at risk of adrenal crisis, a potentially life‐threatening emergency in the peri‐operative period due to their attenuated ability to mount a cortisol response. There is a lack of standardization regarding peri‐operative stress‐dose glucocorticoids in paediatric clinical practice with the absence of agreed protocols. For the individual patient, the risk of adrenal crisis must be weighed against the potential adverse clinical outcomes associated with unnecessary or supra‐physiologic glucocorticoid dosing in susceptible patients. Specific clinical concerns in the paediatric population include osteopenia, growth restriction and increased risk of cardiovascular disease in adulthood. This review aimed to identify and evaluate available literature in the field of peri‐operative stress‐dose glucocorticoids. Methods A comprehensive literature search was conducted to construct a narrative review. Results The outcome of this review identified that paediatric patients, unlike adults, do not show a graded response to surgical stress with implications for glucocorticoid stress dose regimens for general anaesthesia and less invasive surgical procedures. The studies highlight a lack of information on physiological steroid responses to stress situations and differences in the approach to glucocorticoid replacement strategies in the paediatric population. Conclusion The review identified there is a lack of high‐quality paediatric‐specific studies evaluating appropriate stress‐dose glucocorticoid regimens in paediatric patients with or at risk of adrenal insufficiency. Further research is needed to establish clear evidence‐based clinical guidelines for paediatric peri‐operative practice regarding steroid stress dosing in adrenal insufficiency. Current knowledge would suggest that a balanced view of risks and benefits should be taken appropriate to the clinical context, to dictate peri‐operative stress‐dose glucocorticoids use that permits safe perioperative management.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Peri‐operative steroid management in the paediatric population

Heath

Siafarikas

Sommerfield

et al. 2021

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

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Peri‐operative Replacement of Exogenous Steroids (PREdS): a national audit of current peri‐operative prescribing for patients taking therapeutic steroids

Barker,

Ramesh,

Kangesan

et al. 2024

Anaesthesia

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SummaryIntroductionApproximately 1% of the UK population take oral corticosteroids for ≥ 28 days each year, for broadly two reasons: deficiency in corticosteroid requiring replacement; or therapeutic corticosteroid for inflammatory conditions. Acute deficiency can occur at times of physiological stress (e.g. surgery), potentially leading to major complications. The Association of Anaesthetists' 2020 consensus guideline provides detailed advice for the management of glucocorticoids during the peri‐operative period for patients with adrenal insufficiency. This national audit aimed to assess compliance with this guideline.MethodsData were collected from 59 Trusts over 14 consecutive days for all eligible patients undergoing procedures under the care of an anaesthetist. Patients who were prescribed ≥ 5 mg oral prednisolone equivalents pre‐operatively, in whom supplementary corticosteroid would be indicated, were compared with those prescribed < 5 mg oral prednisolone equivalents.ResultsOperations for 21,731 patients were audited: 277 (1.3%) patients were taking therapeutic corticosteroids. Detailed peri‐operative data were collected for all patients receiving therapeutic corticosteroids: 201/277 (73%) were ASA physical status ≥ 3; 184/277 (66%) underwent elective procedures; and 252/277 (91%) were prescribed prednisolone pre‐operatively, of whom 219/277 (79%) were prescribed ≥ 5 mg oral prednisolone equivalents. In the patients who were prescribed ≥ 5 mg oral prednisolone equivalents, 186/219 (85%) received pre‐operative glucocorticoid supplementation and 97/219 (42%) received it postoperatively; however, only 67/219 (31%) and 43/219 (20%) respectively received glucocorticoid supplementation according to the guidelines. Overall, peri‐operative prescribing was compliant in 19/219 (9%) patients. A similar proportion, 30/219 (14%), received no supplementation. In the patients taking < 5 mg oral prednisolone equivalents pre‐operatively, 28/58 (48%) received inappropriate supplementation.ConclusionsDespite 125/277 (45%) of anaesthetists reporting Association of Anaesthetists' guidelines use, compliance remained low, with adherence in only 27/125 (22%) patients. Further research is required to identify the correct peri‐operative strategy for patients taking therapeutic corticosteroids.

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Pneumocystis jiroveci pneumonia after total hip arthroplasty in a dermatomyositis patient: A case report

Mei¹,

Zhang²,

Sun³

et al. 2022

WJCC

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Peri‐operative corticosteroid supplementation for patients on therapeutic glucocorticoids: a national survey

Abstract: 4. Hsu AA, von Elten K, Chan D, et al. Characterization of the cortisol stress response to sedation and anesthesia in children.

Cited by 3 publications

References 2 publications

Peri‐operative steroid management in the paediatric population

Peri‐operative steroid management in the paediatric population

Peri‐operative Replacement of Exogenous Steroids (PREdS): a national audit of current peri‐operative prescribing for patients taking therapeutic steroids

Pneumocystis jiroveci pneumonia after total hip arthroplasty in a dermatomyositis patient: A case report

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