Korean J Anesthesiol Search

CLOSE


Korean J Anesthesiol > Volume 70(1); 2017 > Article
Kim: Small but serious risk of perioperative steroid use
Prophylactic steroid administration is used to prevent airway complications, such as post-extubation laryngeal edema, and to reduce the need for reintubation [1,2]. In this issue, Lee et al. [3] show that topical steroid gargle with 0.05% dexamethasone solution is effective at lowering the severity of postoperative throat discomfort. Preoperative steroid loading is also regarded as essential for managing patients with adrenal insufficiency undergoing surgery [4]. Steroid is frequently used to prevent postoperative nausea and vomiting, a common postoperative complication. Steroid also seems to reduce postoperative pain by modulating anti-inflammatory mediators and the systemic physiological response [5].
Definitive conclusions regarding the effectiveness of perioperative steroid therapy might be precluded by the variability in surgical procedures [6,7]. However, we also need to consider the negative effects of using steroid. Even a single perioperative dose of steroid can be associated with serious side effects [8].
The case report by Kim et al. [9] in this issue shows that the injection of triamcinolone 40 mg to a lumbar nerve root for managing back pain could lead to the rapid development of a central nervous system infection in an immunocompromised patient. This steroid-induced complication progressed to meningitis and, ultimately, to diffuse leptomeningitis. If a lumbar nerve root steroid injection [10,11] is indicated or considered, the clinician must be concerned with possible serious complications such as bleeding, inflammation, or infection.
Despite a lack of supporting evidence, serious side effects of steroid therapy and their impact on the surgical outcome should be included as part of the evaluation of the risks and benefits of steroid therapy.

References

1. Roberts RJ, Welch SM, Devlin JW. Corticosteroids for prevention of postextubation laryngeal edema in adults. Ann Pharmacother 2008; 42: 686–691. PMID: 18413685.
crossref pmid
2. Khemani RG, Randolph A, Markovitz B. Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults. Cochrane Database Syst Rev 2009; (3): CD001000PMID: 19588321.
crossref pmid
3. Lee JH, Kim SB, Lee W, Ki S, Kim M, Cho K, et al. Effects of topical dexamethasone in postoperative sore throat. Korean J Anesthesiol 2017; 70: 58–63.
crossref pmid
4. Hannah-Shmouni F, Demidowich A, Stratakis CA. Cortisol in the Evaluation of Adrenal Insufficiency. JAMA 2016; 316: 535–536. PMID: 27483068.
crossref pmid
5. Callery MP. Preoperative steroids for laparoscopic surgery. Ann Surg 2003; 238: 661–662. PMID: 14578726.
crossref pmid pmc
6. Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 2002; 195: 694–712. PMID: 12437261.
crossref pmid
7. Sauerland S, Nagelschmidt M, Mallmann P, Neugebauer EA. Risks and benefits of preoperative high dose methylprednisolone in surgical patients: a systematic review. Drug Saf 2000; 23: 449–461. PMID: 11085349.
crossref pmid
8. Assante J, Collins S, Hewer I. Infection associated with single-dose dexamethasone for prevention of postoperative nausea and vomiting: a literature review. AANA J 2015; 83: 281–288. PMID: 26390747.
pmid
9. Kim K, Kim YK, Kim S, Shim S, Cho HJ. Cerebrospinal fluid infection after lumbar nerve root steroid injection. Korean J Anesthesiol 2017; 70: 90–94.
crossref pmid
10. Noh SH, Heo DH. Whole cerebrospinal axis infection after lumbar epidural injection: a case report. Eur Spine J 2015; 24(Suppl 4): S525–S528. PMID: 25391626.
crossref pmid
11. Donner B, Tryba M, Strumpf M, Dertwinkel R. Dangers and complications in pain therapy with epidural and intrathecal catheters. Schmerz 1995; 9: 219–234. PMID: 18415528.
crossref pmid


ABOUT
ARTICLE CATEGORY

Browse all articles >

BROWSE ARTICLES
AUTHOR INFORMATION
Editorial Office
101-3503, Lotte Castle President, 109 Mapo-daero, Mapo-gu, Seoul 04146, Korea
Tel: +82-2-795-5129    Fax: +82-2-792-4089    E-mail: anesthesia@kams.or.kr                

Copyright © 2019 by Korean Society of Anesthesiologists. All rights reserved.

Developed in M2community

Close layer
prev next