In Reply

We thank Dr. Wax for his response to our recent article on perioperative steroid management.1 Since the publication of our article, we have received several queries regarding the use of dexamethasone as a perioperative stress-dose steroid and appreciate the opportunity to further address this topic. As Dr. Wax aptly notes, dexamethasone has significantly more glucocorticoid potency than hydrocortisone, has no mineralocorticoid effect, and can be clinically effective in the prevention of postoperative nausea and vomiting. Indeed, the recommended antiemetic dose of dexamethasone (4  mg) has at least the same glucocorticoid equivalence as the recommended intraoperative stress dose of hydrocortisone (100 mg) for patients at risk for adrenal insufficiency undergoing major surgery.1 The available literature on perioperative steroid supplementation provides dosing guidelines based on hydrocortisone, which has a shorter, more predictable half life compared to dexamethasone and is thus more easily tapered to the usual daily dose in patients requiring continued postoperative supplementation based on surgical stress. However, the literature on patients withsecondary adrenal insufficiency does not make any specific recommendation as to what is the “best” stress-dose steroid to administer. Dexamethasone is not appropriate for patients withprimary adrenal insufficiency or critically ill patients, both of whom require mineralocorticoid supplementation.2,3 While we ...
Source: Anesthesiology - Category: Anesthesiology Source Type: research

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Geetanjali T Chilkoti, Anshul Singh, Medha Mohta, Ashok Kumar SaxenaJournal of Anaesthesiology Clinical Pharmacology 2019 35(2):147-152 Various exogenous steroid preparations have been in use for a wide range of indications. We, as an anesthesiologist often encounters a surgical patient receiving chronic steroid therapy. Perioperative use of steroid is associated with major complications such as full-blown adrenal crisis in the perioperative period due to the secondary adrenal insufficiency. Henceforth, comes the role of the perioperative “stress-dose” of steroids to mitigate this rare but potentially fatal co...
Source: Journal of Anaesthesiology Clinical Pharmacology - Category: Anesthesiology Authors: Source Type: research
Marco Vacante1, Antonio Biondi1, Francesco Basile1, Roberto Ciuni1, Salvatore Luca1, Salomone Di Saverio2, Carola Buscemi3, Enzo Saretto Dante Vicari3 and Antonio Maria Borzì3* 1Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy 2Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom 3Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, Catania, Italy There is a high prevalence of hypothyroidism in the elderly population, mainly among women. The mo...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
This article is protected by copyright. All rights reserved. PMID: 30632232 [PubMed - as supplied by publisher]
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
Narendra KumarJournal of Anaesthesiology Clinical Pharmacology 2018 34(2):261-262
Source: Journal of Anaesthesiology Clinical Pharmacology - Category: Anesthesiology Authors: Source Type: research
Purpose of review Review of historical and current evidence of adrenal suppression in patients on chronic glucocorticoid therapy during perioperative period, and discussion of current recommendations for perioperative stress dose steroid administration. Recent findings Evidence suggests low incidence of perioperative adrenal insufficiency in patients receiving chronic glucocorticoid therapy. Recent studies show no difference in survival or hemodynamic sequella by withholding perioperative stress steroids; however, these studies are limited in size and universal applicability. Summary Current recommendations for per...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research
We present the case of an 8‑year-old female child with suspected peroxisomal disorder requiring general anesthesia for adenotomy, paracentesis and brainstem-evoked response audiometry. Peroxisomes are small intracellular organelles that catalyse key metabolic reactions. Peroxisomal disorders are a heterogeneous group of rare genetic diseases. Anesthesia can be challenging as adrenal insufficiency, mental retardation, muscle weakness, risk of pulmonary aspiration, airway complications, seizure disorders and altered pharmacokinetics and pharmacodynamics can occur in these patients but guidelines for anesthesia do not ...
Source: Der Anaesthesist - Category: Anesthesiology Authors: Tags: Anaesthesist Source Type: research
CONCLUSION: Patients with chronic pulmonary conditions have risk of perioperative complications. Their pulmonary treatment regimens should be maintained in the perioperative period to reduce the risk of such complications. PMID: 28925861 [PubMed - as supplied by publisher]
Source: Current Clinical Pharmacology - Category: Drugs & Pharmacology Authors: Tags: Curr Clin Pharmacol Source Type: research
CHRONIC steroid therapy is a cornerstone treatment for many common conditions, including inflammatory bowel disease, rheumatologic disease, reactive airway disease, and immunosuppression for transplant recipients. Patients on chronic steroid therapy may develop secondary adrenal insufficiency that can manifest as full-blown adrenal crisis in the perioperative period. When these patients present for surgery, the anesthesiologist must decide whether to administer perioperative stress-dose steroids to mitigate this rare but potentially fatal complication of chronic steroid use. In doing so, the patient ’s risk for adren...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Pedro Reis, Joana MourãoSaudi Journal of Anaesthesia 2017 11(1):106-107 Septo-optic dysplasia (SOD)/de Morsier's syndrome is characterized by optic nerve hypoplasia, pituitary endocrine dysfunction, and midline brain abnormalities. Hypopituitarism, hypothyroidism, hypogonadism, and adrenal insufficiency can lead to severe hypoglycemia, adrenal crisis, seizures, and sudden death. Anesthetic management of SOD was associated with high perioperative mortality. A 9-year-old male child proposed for dental treatments/extractions. Medical history of SOD with hypopituitarism, hypothyroidism, and delayed psychomotor develo...
Source: Saudi Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
To investigate whether steroid replacement therapy improved hemodynamics in infants after surgery for congenital heart disease only when they develop adrenal insufficiency. The authors retrospectively investigated adrenal function and evaluated hemodynamic responses to steroid replacement therapy in infants after surgery for congenital heart disease.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
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