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High-dose perioperative corticosteroids in steroid-treated patients undergoing major colorectal surgery: necessary or overkill?
MedLine Citation:
PMID:  22748293     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Steroid-treated patients undergoing major colorectal surgery are routinely treated with high-dose steroids (HDS) to prevent perioperative adrenal insufficiency and cardiovascular collapse. However, there is no evidence to support this practice. METHODS: A retrospective analysis of 97 consecutive steroid-treated patients with inflammatory bowel disease who underwent major colorectal surgery was performed. The incidence of hemodynamic instability and surgical outcomes were compared in patients treated with perioperative low-dose steroids (LDS) versus HDS. RESULTS: Forty-three patients were treated with HDS, and 54 patients received LDS. There was no significant difference in hemodynamic instability between HDS-treated (74%) and LDS-treated (78%) patients. No patients required rescue HDS for adrenal insufficiency. CONCLUSIONS: Steroid-treated patients with inflammatory bowel disease undergoing major colorectal surgery appear to have no clinically significant hemodynamic instability when managed with LDS versus HDS. A prospective study assessing perioperative steroid dosing in patients with inflammatory bowel disease is in progress.
Authors:
Karen N Zaghiyan; Zuri Murrell; Gil Y Melmed; Phillip R Fleshner
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-28
Journal Detail:
Title:  American journal of surgery     Volume:  -     ISSN:  1879-1883     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-7-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Published by Elsevier Inc.
Affiliation:
Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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