Postoperative postural hypotension or adrenal insufficiency in patients with inflammatory bowel disease can be effectively prevented with low-dose rather than high-dose steroids, according to data published in the June 14 online issue of Annals of Surgery [doi: 10.1097/SLA.b013e318297adca].
“Corticosteroid-treated patients undergoing major colorectal surgery are commonly prescribed high-dose steroids to prevent perioperative adrenal insufficiency and cardiovascular collapse,” wrote Dr. Karen Zaghiyan and her colleagues from Cedars-Sinai Medical Center, Los Angeles. “There is little evidence to support this practice.”
A randomized, single-blinded noninferiority trial in 92 steroid-treated inflammatory bowel disease (IBD) patients undergoing major colorectal surgery showed that 96% of patients randomized to low-dose steroids and 95% of patients randomized to high-dose steroids did not exhibit postural hypotension on the first day after surgery (noninferiority 95% confidence interval, –0.08 to 0.09; P = .007).
“Because reports of postoperative adrenal insufficiency and hemodynamic collapse have implicated the first 24 hours after surgery as the most susceptible, and postural hypotension is likely to be a more reliable indicator of hemodynamic instability than supine hypotension, our primary endpoint was clinically meaningful,” the researchers reported. Read more.