Depth of Anesthesia

25: Should stress-dose steroids be given?

Jun 8, 2021
Guest
Jonathan Charnin
Guest
Daniel Saddawi-Konefka
Dr. Jonathan Charnin, an anesthesiology assistant professor at Mayo Clinic, and Dr. Daniel Saddawi-Konefka, residency program director at Massachusetts General Hospital, dive into the critical role of stress-dose steroids in managing adrenal insufficiency. They discuss a clinical case of a woman with rheumatoid arthritis and examine the implications of adrenal suppression during surgery. The conversation also covers the complexity of adrenal function, the history of steroid use, and the necessity for monitoring adrenal responses in patients on chronic therapy.
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INSIGHT

Cortisone History and Early Concerns

  • Cortisone's use began in 1948, initially for rheumatoid arthritis.
  • Two early 1950s case reports linked cortisone use to adrenal atrophy and death, sparking concerns about adrenal insufficiency.
INSIGHT

Chronic Steroid Use and Adrenal Insufficiency

  • Patients on >20mg/day of prednisone for >3 weeks likely have suppressed HPA axis function.
  • A meta-analysis revealed about a 50% chance of adrenal insufficiency in patients taking oral corticosteroids.
INSIGHT

Surgery and Adrenal Response

  • Surgery triggers stress and inflammation, necessitating an adrenal response involving cortisol.
  • Insufficient adrenal response can cause hypotension, abdominal pain, and other symptoms.
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