An evidence-based review on the use of corticosteroids in peri-operative and critical care
Journal
Acta Anaesthesiologica Sinica
Journal Volume
40
Journal Issue
2
Pages
71-79
Date Issued
2002
Author(s)
Abstract
With complex and extensive pharmacological effects, corticosteroids are widely used in many clinical situations. A survey conducted to define the role of corticosteroids in various settings of peri-operative and critical care gave strong evidence to support that the use of corticosteroid is absolutely indicated in patients with adrenal insufficiency, asthma, anaphylaxis, acute spinal cord injury, and increased ICP resulting from brain tumors. As the benefits of corticosteroids are much in evidence, their uses are recommended to extend to postoperative antiemesis, acute respiratory failure (such as ARDS, COPD, and fat embolism), increased ICP associated with brain abscess, thyroid storm, and refractory hypothermia. Beneficial effect could be expected in septic shock with high-dose corticosteroids. Despite extensive reports on their versatile usefulness, evidence-based review did not recommend the use of corticosteroids in increased ICP associated with traumatic head injury and cerebral infarct, cardiac arrest, post-extubation airway edema, and aspiration pneumonia due to poor effectiveness let alone further worsening of the conditions. Great caution must be taken in clinical situations where administration of corticosteroids is considered contraindicated such as systemic fungal infection, hypersensitivity to the drug, intramuscular injection in idiopathic thrombocytopenia purpura, vaccination with live virus.
Subjects
Adrenal cortex hormones; Critical care; Perioperative care
SDGs
Other Subjects
adrenalin; beta 2 adrenergic receptor stimulating agent; betamethasone; budesonide; cholinergic receptor stimulating agent; corticosteroid derivative; cortisone; dexamethasone; glucocorticoid; hydrocortisone; hydrocortisone sodium succinate; live vaccine; methylprednisolone; methylprednisolone sodium succinate; mineralocorticoid; placebo; prednisolone; prednisone; steroid; triamcinolone; triamcinolone acetonide; triamcinolone hexacetonide; acute respiratory failure; adrenal insufficiency; adult respiratory distress syndrome; anaphylactic shock; aspiration pneumonia; asthma; brain abscess; brain infarction; brain tumor; chronic obstructive lung disease; clinical trial; critical illness; drug antagonism; drug contraindication; drug effect; drug efficacy; drug half life; drug hypersensitivity; drug indication; drug megadose; drug use; edema; evidence based medicine; fat embolism; head injury; heart arrest; human; hypothermia; idiopathic thrombocytopenic purpura; intracranial hypertension; mycosis; perioperative period; postoperative care; review; septic shock; spinal cord injury; thyroid crisis; vaccination; vomiting; Adrenal Cortex Hormones; Adrenal Insufficiency; Asthma; Critical Care; Evidence-Based Medicine; Glucocorticoids; Humans; Intracranial Pressure; Perioperative Care; Spinal Cord Injuries
Type
review