RT Book, Section
A1 Hoffmann, Clément
A1 Tourtier, Jean-Pierre
A2 Atchabahian, Arthur
A2 Gupta, Ruchir
SR Print(0)
ID 57260366
T1 Chapter 11. Patient on Corticosteroids
T2 The Anesthesia Guide
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-176049-2
LK accessanesthesiology.mhmedical.com/content.aspx?aid=57260366
RD 2024/04/25
AB Corticosurrenal  production  under  control  of  the  hypothalamic–pituitary  axis  of:Glucocorticosteroids  (cortisol  [=  hydrocortisone]  and  corticosterone)Mineralocorticosteroids  (aldosterone)Basal  corticosteroid  production  in  an  adult  patient  =  5–10  mg/m2  per  day  of  cortisol  (equivalent  to  5–7  mg  prednisone  or  20–30  mg  hydrocortisone  for  an  average  adult)If  extrinsic  steroid  therapy  administered,  negative  feedback  to  the  hypothalamic–pituitary  axis  and  inhibition  of  the  corticoadrenal  productionIn  case  of  stress  (such  as  surgery,  disease,  physical  exertion,  pregnancy),  the  normal  protective  surge  in  systemic  cortisol  will  be  inhibited,  thus  putting  the  patient  at  risk  of  acute  adrenal  insufficiencyNormal  daily  secretion  of  cortisol  in  the  perioperative  period  (about  72  hours):Minor  surgery:  25  mgModerate  surgery:  50–75  mgMajor  surgery:  100–150  mgStress-dose  steroid  replacement  should  be  commensurate  to  the  need;  if  excessive,  risk  of  infectious  complications,  delayed  wound  healing,  and  disturbed  metabolic  regulation  (hyperglycemia)