When Should Perioperative Glucocorticoid Replacement Be Administered?

ABSTRACT

Perioperative glucocorticoid replacement has been used in a variety of clinical conditions. Glucocorticoids have several benefits, such as antiinflammatory and immunosuppressant effects. Routine perioperative use, however, has been limited by side effects, lack of efficacy, and conflicting trial results. Nevertheless, glucocorticoid replacement is indicated in certain situations, including refractory septic shock, early moderate-to-severe acute respiratory distress syndrome, severe COVID-19, and relative adrenal insufficiency in patients undergoing surgical procedures. Further investigations are required to determine optimal glucocorticoid dosing and timing, identify patient subsets who benefit from replacement therapy, and reconcile conflicting results from clinical studies.