Patient on steroid therapy during surgery requires:
Correct Answer: Hydrocortisone only
Description: Ans: a (Hydrocortisone only) Ref: Bailey, 24th ed, p. 44Patients who are receiving adrenocortical steroid therapy by any route (IM, IV, inhalational) or who have received them in the past 2 months will have suppressed adrenal glands and will be unable to respond to the increased steroid requirement during and after surgery* Supplementation with regular hydrocortisone is given to avoid acute adrenal insufficiency (Addisonian crisis)* Management of Diabetes mellitusa) IDDM* If the patient is posted for minor surgery (<20 min) no adjustment in doses of insulin is required* For major surgery switch over to short duration regular insulinb) NIDDM* If posted for minor surgery oral hypoglycaemics are continued as such omitting the morning dose on the day of surgery* If posted for major surgery, the patient should be switched over to regular insulin 48 to 72 hrs before surgeryAcute adrenal insufficiency (Addisonian crisis) can be triggered in steroid-dependent patients, who do not receive increased dose during stress, like trauma, infection, or surgery.Patients receiving any steroids equivalent to 5 mg of prednisolone by any route of administration, for a period of > 2 weeks, may be unable to respond to stress like surgery.200 mg hydrocortisone should be given perioperatively or 25 mg at the time of induction, followed by 100 mg infusion during 24 hours.
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