postoperative crisis/ccm board review

8/10/2019 Postoperative Crisis/CCM board review

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Preoperative glucocorticoid Rx major risk factor

Not seen with prednisone equivalent !5 mg/day; < 3 weeks

Etomidate suppresses 11 #-hydroxylase ~24 72 h

Hypotension or manifestations of AI very uncommon insurgical patients (as opposed to septic shock)

Doses of hydrocortisone ~50 mg IV q8h PLENTY

Maximal stress response of adrenals < 300 mg/day

High dose (250 mcg) ACTH stimulation testingunderestimates incidence of HPA axis suppression

But no demonstrably superior alternative

Cortisol assays highly variable

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postoperative crisis/ccm board review

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