Perioperative Steroid Management Approaches Based on Current Evidence

CHRONIC steroid therapy is a cornerstone treatment for many common conditions, including inflammatory bowel disease, rheumatologic disease, reactive airway disease, and immunosuppression for transplant recipients. Patients on chronic steroid therapy may develop secondary adrenal insufficiency that can manifest as full-blown adrenal crisis in the perioperative period. When these patients present for surgery, the anesthesiologist must decide whether to administer perioperative stress-dose steroids to mitigate this rare but potentially fatal complication of chronic steroid use. In doing so, the patient ’s risk for adrenal crisis must be weighed against the risks of unnecessary steroid supplementation. Unfortunately, this decision is not always clear-cut, because even the recommendations found in major textbooks are confusing, inconsistent, and lacking in class A and B evidence (table 1). Despite the lack of standardization and the widespread use of perioperative stress-dose steroids observed in clinical practice, a recent search of the Anesthesia Closed Claims Project database containing 11,247 claim narratives using the terms “stress dose,” “Cushing,” “Addison,” and “adrenal insufficiency” revealed that failure to administer stress steroids generated only two claims that resulted in liability payments, and both of these cases were complicated by other issues (written personal communication, Karen L. Posne r, Ph.D., Departmen...
Source: Anesthesiology - Category: Anesthesiology Source Type: research

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ConclusionsPA activates PXR signalling and suppresses NF-κB signalling, consequently causing ameliorating inflammation. Results highlight the importance of PXR–NF-κB crosstalk in colitis and suggest a novel therapeutic reagent.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
ConclusionsThis study suggests that PLS exhibits anti-inflammatory action against intestinal damage by reducing inflammatory cell infiltration, oxidative stress, pro-inflammatory action of cytokines, and COX-2 expression in the inflamed colon. PLS shows therapeutic potential against inflammatory disorders like UC.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
Conclusions: The DC-TAV program is an ambitious, civilian-military, nationwide and long-term program, based on a harmonised standard of care and including multidimensional training. Further studies are required to assess its efficacy.
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 12 October 2019Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Arnaud Chaumeron, Jeremie Castanie, Louis Philippe Fortier, Patrick Basset, Sophie Bastide, Sandrine Alonso, Jean-Yves Lefrant, Philippe CuvillonABSTRACTBackground: Rapid sequence induction (RSI) is recommended in patients at risk of aspiration, but induced hemodynamic adverse events, including tachycardia. In elderly patients, this trial aimed to assess the impact of the addition of remifentanil during RSI on the occurrence of: tachycardia (primary outcome), hypertension (due to intubation) nor hypotension (rem...
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 13 October 2019Source: Brazilian Journal of Anesthesiology (English Edition)Author(s): Yuichi Ohgoshi, Yosuke Usui, Satoshi Terada, Yoshimasa Takeda, Aiji Ohtsuka
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
ConclusionsThis case series demonstrates that the use of a high frequency jet ventilator for cardiac MRI was feasible, safe, providing good quality cardiac imaging and avoiding anesthesia personnel to be inside the hazardous environment of MRI room. Future studies are needed to confirm its safety and efficiency in pediatric patients.ResumoJustificativa e objetivosA ressonância magnética (RM) cardíaca é uma técnica utilizada na avaliação de crianças com cardiopatias congênitas. A anestesia geral garante imobilidade, especialmente em pacientes não cooperador...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
Publication date: Available online 12 October 2019Source: Anesthesiology ClinicsAuthor(s): Anne D. Cherry
Source: Anesthesiology Clinics - Category: Anesthesiology Source Type: research
Publication date: Available online 12 October 2019Source: Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)Author(s): Q. Xu, M. Lv, Y. Xia, Y. Zhao, W. Zhang, Y. ChenAbstractA 42-year-old woman presented with a ten-day history of dysphagia, slight chest pain and occasional vomiting. With the performance of thoracic and abdominal enhanced computed tomography (CT) and upper gastrointestinal contrast, once esophageal cancer was suspected. Significant activity mass in esophagus and mediastinal lymph nodes could be found on the imaging of 18F-FDG PET/CT, which also supported malignancy. However, T...
Source: Revista Espanola de Medicina Nuclear e Imagen Molecular - Category: Nuclear Medicine Source Type: research
Publication date: Available online 8 October 2019Source: NeuroImageAuthor(s): In-Seon Lee, Elizabeth A. Necka, Lauren Y. AtlasAbstractPain is a subjective, multidimensional experience that is distinct from nociception. A large body of work has focused on whether pain processing is supported by specific, dedicated brain circuits. Despite advances in human neuroscience and neuroimaging analysis, dissociating acute pain from other sensations has been challenging since both pain and non-pain stimuli evoke salience and arousal responses throughout the body and in overlapping brain circuits. In this review, we discuss these chal...
Source: NeuroImage - Category: Neuroscience Source Type: research
ConclusionsThe current rapid, multi-slice acquisition and real-time implementation of temperature and displacement visualization may be useful in clinical practices. It may help defining operational safety margins, improving therapy precision and efficacy. Simulations were in good agreement with experimental data and may thus be used prior treatment for procedure planning.
Source: NeuroImage - Category: Neuroscience Source Type: research
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