Steroid Management in Patients Undergoing Surgery for IBD

Abstract

Often faced with the challenge of operating on steroid-treated patients with inflammatory bowel disease (IBD), colorectal surgeons must be well versed in the perioperative steroid management of this patient cohort. Historically, standard practice has entailed stress-dose or high-dose perioperative steroids in these patients undergoing surgery to prevent perioperative adrenal insufficiency (AI), cardiovascular collapse and death. Stress-dose steroids typically consist of hydrocortisone 100 mg intravenous (IV) given preoperatively and continued every 8 h postoperatively with a taper down to the preoperative dose over 2–3 days [1]. However, this practice is anecdotal and largely based on case reports from the 1950 s [2, 3] demonstrating cardiovascular collapse and death in 2 patients whose steroids were abruptly discontinued before surgery.