Corticosteroids are a class of medications, such as prednisone or hydrocortisone, widely used for their potent anti-inflammatory and immunosuppressive properties. They treat various conditions including autoimmune diseases, allergies, asthma, and inflammatory bowel disease. For individuals on long-term corticosteroid therapy, managing these medications before surgery is a complex medical decision. This requires careful consideration and close consultation with healthcare professionals to ensure patient safety.
The Body’s Natural Response and Steroid Impact
The human body naturally produces cortisol, a steroid hormone from the adrenal glands. Cortisol plays a multifaceted role, influencing metabolism, immune function, blood pressure, and the sleep-wake cycle. It is also a central component of the body’s stress response system, enabling it to cope with physical and psychological demands.
Prolonged use of external corticosteroids can suppress this natural production of cortisol. This occurs because the body perceives the external steroids as sufficient, signaling the adrenal glands to reduce their own output. This condition is known as adrenal insufficiency or hypothalamic-pituitary-adrenal (HPA) axis suppression. If external steroids are suddenly stopped, the body may be unable to produce enough cortisol to handle the physiological stress of surgery. Adrenal suppression is generally anticipated in patients taking the equivalent of 7.5 mg of prednisone daily for more than three weeks.
Potential Complications During Surgery
Improper management of corticosteroids before or during surgery can lead to significant health risks. A major concern is an adrenal crisis, or acute adrenal insufficiency, if steroid therapy is abruptly withdrawn. In this situation, the body lacks sufficient cortisol to respond to surgical stress, leading to symptoms such as severe low blood pressure, shock, and electrolyte imbalances. Without immediate treatment, an adrenal crisis can rapidly progress.
Corticosteroids can also impair wound healing by reducing collagen synthesis and fibroblast activity, which are essential for tissue repair. This can delay surgical incision closure and increase the risk of wound dehiscence. The immunosuppressive effects of these medications can heighten susceptibility to infections during the perioperative period. Steroids can also elevate blood sugar levels, leading to hyperglycemia, which complicates glycemic control and increases infection risk.
Pre-Surgical Steroid Management Guidelines
Individuals on corticosteroid therapy must never stop or adjust their medication without explicit medical advice. The management plan for steroids before surgery is highly individualized, considering the steroid type, dosage, duration of use, the patient’s underlying health condition, and the nature of the surgical procedure. This tailored approach ensures the body can adequately handle surgical stress while minimizing potential side effects.
One common strategy is stress dosing, which involves administering higher doses of steroids around the time of surgery. This mimics the body’s natural increase in cortisol during stress, preventing acute adrenal insufficiency. For some patients on long-term therapy, a gradual tapering of the steroid dose before surgery may be considered. This slow reduction allows the adrenal glands to recover their natural function. Open communication among the patient, surgeon, anesthesiologist, and potentially an endocrinologist is essential for a safe and effective plan. Providing a complete medical history, including all medications, is a fundamental step in pre-surgical planning.