Peri‐operative steroid management in the paediatric population

Abstract

Patients with adrenal insufficiency are at risk of adrenal crisis, a potentially life‐threatening emergency in the peri‐operative period due to their attenuated ability to mount a cortisol response. There is a lack of standardization regarding peri‐operative stress‐dose glucocorticoids in paediatric clinical practice with the absence of agreed protocols. For the individual patient, the risk of adrenal crisis must be weighed against the potential adverse clinical outcomes associated with unnecessary or supra‐physiologic glucocorticoid dosing in susceptible patients. Specific clinical concerns in the paediatric population include osteopenia, growth restriction and increased risk of cardiovascular disease in adulthood. This review aimed to identify and evaluate available literature in the field of peri‐operative stress‐dose glucocorticoids.