Pre-operative and Post-operative Care of Patients Receiving Cortisone or Other Steroid Therapy

Surgical operations may be hazardous on patients who are being treated with steroid hormones or who have recently received such therapy. This is a problem which is likely to occur more frequently now that cortisone and the A,-steroids, prednisone and prednisolone have been made generally available. The situation may arise in one of two ways. First, the patient may be receiving small (physiological) doses of cortisone as replacement therapy for adrenal insufficiency, due either to Addison's disease, to panhypopituitarism or to total adrenalectomy. Secondly, patients may be receiving large (pharmacological) doses of cortisone or A,-steroids for the treatment of such conditions as rheumatoid arthritis, collagen disease or ulcerative colitis. Such patients may have to undergo surgical operations on account of some incidental disease or for specific complications of steroid therapy such as perforation of a peptic ulcer. While they are receiving steroid hormones in large doses, and for some months or a year or more after steroid therapy has been discontinued, these patients are suffering from potential adrenal insufficiency due to suppression of endogenous adrenal cortical function. Careful pre-operative assessment and management of patients with actual or potential adrenal insufficiency is of vital importance. Post-operative care is but a continuation of the pre-operative regime; to postpone treatment until after the operation may be to court disaster, for it is often difficult to resuscitate the patient once profound adrenal failure has supervened.