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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The coronavirus disease 2019 (COVID-19) is an emerging pandemic challenge. Acute respiratory distress syndrome (ARDS) in COVID-19 is characterized by a severe cytokine storm. Patients undergoing glucocorticoid (GC) replacement therapy for adrenal insufficiency (AI) represent a highly vulnerable group that could develop severe complications due to the SARS-CoV-2 infection. In this review, we highlight the strategies to avoid an adrenal crisis in patients with AI and COVID-19. Adrenal crisis is a medical emergency and an important cause of death. Once patients with AI present symptoms of COVID-19, the dose of GC replacement ...
Source: Clinics - Category: General Medicine Source Type: research
Nature Reviews Endocrinology, Published online: 09 March 2020; doi:10.1038/s41574-020-0342-zCurrent recommendations for perioperative doses of hydrocortisone in patients with adrenal insufficiency undergoing major surgery with general anaesthesia have been examined in a new paper. Compared with current guidelines, lower doses of hydrocortisone, tapered quickly back to baseline levels of glucocorticoids, were found to be effective and safe.
Source: Nature Reviews Endocrinology - Category: Endocrinology Authors: Source Type: research
The Society for Endocrinology, the Association of Anaesthetists and the Royal College of Physicians have published newGuidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency.You can access the guidelines from theAnaesthesia journal website.The guidelines provide eight recommendations and aim to ensure that patients with adrenal insufficiency are identified and adequately supplemented with glucocorticoids during the peri-operative period.  Anaesthetists must be familiar with the symptoms and signs of acute adrenal insufficiency so that inadequate su...
Source: Society for Endocrinology - Category: Endocrinology Source Type: news
CONCLUSIONS: Preoperative steroid administration may be unnecessary in patients without AI undergoing ETSS for nonfunctioning pituitary adenomas. However, a further large-scale study is needed to determine whether preoperative steroid administration has a significant impact on clinically meaningful events such as perioperative AI and postoperative 3-month ACTH deficiency in these patients.Korean Clinical Trial Registry no.: KCT0002426 ( PMID: 31978882 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery - Category: Neurosurgery Authors: Tags: J Neurosurg Source Type: research
CONCLUSIONS: With the availability of skilled pediatric anesthesia care, children with X-linked adrenoleukodystrophy can undergo procedures under anesthesia in sedation units and regular operating rooms with low overall anesthesia risk. PMID: 31841242 [PubMed - as supplied by publisher]
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
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
More News: Addison's Disease | Adrenal Insufficiency | Anesthesia | Anesthesiology | Dexamethasone | Hydrocortisone