Stress dosing in adrenally insufficient patients substantially exceed requirements

[wtbcrna, MSN, DNP, CRNA]

J Clin Endocrinol Metab. 2013 Sep;98(9):3687-93. doi: 10.1210/jc.2013-2148. Epub 2013 Jul 16.

[h=1]Cortisol response to operative stress with anesthesia in healthy children.[/h]

Taylor LK, Auchus RJ, Baskin LS, Miller WL.

[h=3]Source[/h]Department of Pediatrics, HSE-1401, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, California 94143-0978. [email protected].

[h=3]Abstract[/h]Background: Supraphysiological "stress dosing" is generally given to adrenally insufficient patients undergoing operative procedures and/or general anesthesia. However, the normal responses of cortisol to surgery are poorly documented, especially in small children. Recent studies in adults suggest that massive glucocorticoid dosing is not needed, especially in minimally invasive surgery. Objective: We sought to characterize the normal cortisol secretion rate in healthy children undergoing minimally and moderately invasive urological procedures. Design and Setting: This was a prospective observational study conducted at a tertiary referral center. Patients: Thirty healthy children, ages 5 months to 6 years, were studied undergoing elective urological procedures. Methods: Procedures were performed by a single surgeon; anesthesia was by a standard protocol. Sera were obtained at 5 points: iv catheter placement, intubation, 50% completion of surgery, anesthesia reversal, and 1 hour postoperative. Cortisol and cortisone were quantitated by liquid chromatography-tandem mass spectrometry. Results: Group mean cortisol values ranged from 4.21 to 5.71 μg/dL across the 5 time points; none of these mean values differed significantly (P

http://www.ncbi.nlm.nih.gov/pubmed/23861461

[puppies'n kittens]

Question about subjects like these are what I would love to see in the recert exam... Then we will find out who keeps up on the science and who sits on a stool not learning a thing since school.