A rational approach to dosage and preparation of parenteral glucocorticoid substitution therapy during surgical procedures. A short review.

Acta Anaesthesiologica Scandinavica
H Kehlet

Abstract

A rational physiological schedule for parenteral glucocorticoid substitution therapy during surgical procedures is proposed based on the principle of imitating the normal hypothalamic-pituitary-adrenocortical response to surgery. The schedule includes the injection of 25 mg cortisol intravenously in all patients together with induction of anaesthesia. Following major surgery, 100 mg cortisol dissolved in saline or glucose is continuously infused intravenously every 24 hours until gastrointestinal function permits oral intake of usual glucocorticoid substitution therapy. In case continuous cortisol infusion is undesirable, 25 mg cortisol is injected intravenously every four hours. Following minor surgery, usual oral glucocorticoid therapy is started immediately after the operation. It is recommended to use water-soluble cortisol preparations and not cortisone acetate, which results in limited plasma cortisol levels.

References

Jul 1, 1966·The Journal of Clinical Endocrinology and Metabolism·E M Bradley, C Waterhouse
Jul 1, 1966·Metabolism: Clinical and Experimental·Y Ichikawa
Aug 1, 1972·The Surgical Clinics of North America·J L Gabrilove, G L Nicolis
Feb 1, 1974·Proceedings of the Society for Experimental Biology and Medicine·J R ZucaliA S Gordon
Feb 1, 1973·The Journal of Clinical Endocrinology and Metabolism·H Kehlet, C Binder
May 1, 1974·Acta Medica Scandinavica·H KehletC Binder
Dec 1, 1970·The Journal of Clinical Endocrinology and Metabolism·T F GallagherL Hellman
Jul 1, 1972·The Journal of Clinical Endocrinology and Metabolism·A DazordJ Bertrand
Jul 1, 1970·The British Journal of Oral Surgery·P Banks
Sep 1, 1969·Canadian Anaesthetists' Society Journal·T Oyama
May 1, 1971·American Journal of Surgery·F O StephensJ E Dunphy
Apr 22, 1967·British Medical Journal·J S Jenkins, P A Sampson
Sep 1, 1967·The Journal of Endocrinology·A SpätA Fazekas
Sep 1, 1957·The Journal of Clinical Investigation·R E PETERSONB B BRODIE
Apr 1, 1960·The Journal of Clinical Endocrinology and Metabolism·R E PETERSONR L BLACK
Aug 18, 1962·Lancet·P A SAMPSONB N BROOKE

❮ Previous
Next ❯

Citations

Mar 1, 1995·Journal of General Internal Medicine·R L Schiff, M A Emanuele
May 1, 1979·Canadian Anaesthetists' Society Journal·H IshiharaT Oyama
Aug 30, 2001·Burns : Journal of the International Society for Burn Injuries·S A DeebJ A Griswold
Jan 5, 2002·Journal of the American College of Surgeons·C J Brown, W D Buie
Feb 19, 1999·Anaesthesia·G NicholsonG M Hall
Apr 16, 2004·The New England Journal of Medicine·Lynn Loriaux
Jan 1, 1978·Anaesthesia·L Gran, J A Pahle
Apr 1, 1995·Postgraduate Medical Journal·J Richardson
Apr 1, 1986·The Journal of Clinical Investigation·R UdelsmanG P Chrousos
May 1, 1987·Baillière's Clinical Endocrinology and Metabolism·R C Gaillard, S Al-Damluji
May 1, 1987·Baillière's Clinical Endocrinology and Metabolism·R N Barton
Sep 12, 2006·The Surgical Clinics of North America·James Whiting
Aug 17, 2006·Oral Diseases·S K Baid, L K Nieman
Jun 11, 2009·Clinical Endocrinology·Phillipa C RainsKim C Donaghue
Feb 1, 1993·Burns : Journal of the International Society for Burn Injuries·R L SheridanR G Tompkins
Feb 16, 2002·The Annals of Thoracic Surgery·Marc de PerrotShaf Keshavjee
May 21, 2011·Revista brasileira de anestesiologia·Eneida Maria VieiraPedro Paulo Tanaka
Jul 1, 1984·The Veterinary Clinics of North America. Small Animal Practice·M E PetersonC J Mehlhaff
Sep 11, 2014·Inflammatory Bowel Diseases·Caitlin W HicksChristina Y Ha
Aug 2, 2017·Clinical Endocrinology·Bernard KhooTricia Tan
Sep 8, 2017·European Journal of Endocrinology·Stina Willemoes BorresenUlla Feldt-Rasmussen
May 8, 2007·Clinical Orthopaedics and Related Research·Asha TyagiAshok Kumar Sethi
Jun 30, 2007·Current Opinion in Critical Care·Josef BriegelGustav Schelling
Jul 4, 2006·International Journal of Language & Communication Disorders·Frances Cook, Jane Fry
Dec 12, 2017·Current Opinion in Anaesthesiology·Leon Freudzon
Jan 31, 2020·The Journal of Clinical Endocrinology and Metabolism·Baha M Arafah
Nov 1, 1993·Anaesthesia·M A Skues, E A Welchew
Sep 21, 2019·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Amalie ValentinUlla Feldt-Rasmussen
Mar 18, 2020·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Henrik Kehlet
Aug 31, 2019·The Orthopedic Clinics of North America·Karen M Bovid, Mary D Moore
Apr 9, 2008·The Medical Journal of Australia·Caroline Jung, Warrick J Inder
Jul 16, 2021·Acta Anaesthesiologica Scandinavica·Chloe HeathBritta S von Ungern-Sternberg
Mar 1, 1983·Clinical Reviews in Allergy·S C Siegel

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.