Why are supplemental steroids given to adrenally suppressed patients during the perioperative period?

Supplemental steroids are given to adrenally suppressed patients during the perioperative period primarily to prevent hypotension and hypoglycemia. Patients who are chronically on steroids, such as those with adrenal insufficiency, have an impaired ability to produce cortisol in response to stress, including surgical stress. Cortisol plays a crucial role in maintaining blood pressure and blood glucose levels, especially during times of physiological stress.

In the context of surgery, the body undergoes increased metabolic demands and stress responses that typically trigger the normal adrenal glands to secrete more cortisol. If a patient has suppressed adrenal function, their body may not respond adequately to these demands, putting them at risk of complications like hypotension due to insufficient vascular tone, and hypoglycemia due to inadequate glucose production. Therefore, administering supplemental steroids helps to mimic the natural increase in cortisol that would occur during a surgical stress response, thereby ensuring hemodynamic stability and maintaining normal glucose levels.

While enhancement of wound healing, reduction of inflammation, and pain management are also important considerations in patient care, they are not the primary reasons for the administration of supplemental steroids in an adrenally suppressed patient during surgery. The primary focus is on maintaining vital physiological functions that are critical during the perioperative phase.