[Glucocorticoid treatment may need to be adjusted during operations. Hospital guidelines reduces the risk of adrenal insufficiency].

In Sweden 200 000 patients annually receive corticosteroid treatment for inflammatory and immunological diseases. Corticosteroid treatment has adverse effects that are common and serious, but lack of corticosteroids can be life threatening. Supplemental perioperative corticosteroid treatment, stress dose, was prompted by two case reports in the 1950s describing patients on corticosteroid treatment that died after surgery. A review of studies identified 328 surgical patients on corticosteroid treatment who did not receive a stress dose. Two of these patients developed clinical symptoms of adrenal insufficiency and they had not received any corticosteroids for 36 and 48 hours respectively. None of the patients receiving their usual daily dose of corticosteroid developed signs of adrenal insufficiency. Since mid 2013 a guideline at Södersjukhuset, Stockholm, dictates exclusion of stress dose to patients who undergo elective surgery and are able to take their usual daily oral dose of corticosteroids. If the daily dose has not been taken glucocortidcoids should be given as iv infusion. All patients on corticoid treatment should be monitored for signs of adrenal insufficiency.