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Background and Goal of Study: Chronic steroid administration is a cornerstone treatment for a variety of medical conditions but may induce secondary adrenal insufficiency. Perioperative cessation of chronic steroid treatment may result in a full – blown adrenal crisis. Related to surgical severity, recently published guidelines file specific recommendations. The goal of this survey was to assess the knowledge and practical adherence to guidelines on perioperative use of steroids between Belgian anesthesiologists and endocrinologists. Materials and Methods: A paper survey was handed out and collected at the annual meetings of the Society of Anesthesia and Reanimation of Belgium (SARB) and the Belgian Endocrine Society (BES) in 2016. Results and Discussion: Only 50% of the responders had a hospital-based stress dosing protocol available. Eighty – one percent of the respondents would continue the patients’ daily steroid dose on the day of surgery and 92% would add a steroid stress dosing schedule, respectively. Definition of the stress dose varied substantially. Fifty percent of respondents indicated 40 mg hydrocortisone as initiation threshold; 64% would add stress dosing schedule in alternate day therapy and 9 respondents additionally differentiated between primary and secondary hypocortisolism. Even with proof of functioning adrenal glands, 84% initiated stress dose treatment. For minor surgery, 61% limited the treatment to the day of surgery. For intermediate and major surgery, respectively 31% and 10% only supplemented for the day of surgery. Longer treatment continuation was preferred up to 1 day after surgery by anesthesiologists. Endocrinologists seemed to advocate a longer duration of supplemental therapy. Conclusions: The results of this survey illustrate a void between contemporary practice and the recently published guidelines for perioperative steroid stress dosing. The paucity of available evidence and the illustrated variety in clinical practice serve as a call for adequate randomized controlled trials to generate relevant and reliable evidence.

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© Copyright 2019 Morressier GmbH.
All rights reserved.