Cortisone Problems Involving Anesthesia

Preoperative examination and preparation of problem patients

“…No clear-cut answer could be found to such questions as to what dose of cortisone administered over what period of time is necessary to produce adrenal-cortical suppression. Lundy and Pender of The Mayo Clinic (10,11) consider that there is danger for anyone who has received cortisone within three to s~x months before the proposed operation, particular notice being given those who show symptoms of hyper cortinism (rounding of face, hypertension, peripheral oedema, hirsutasm, pads of fat on the back of the neck). They seem to require special preparataon unless they have had no cortisone for twelve months.…”

Some Endocrine Problems in Anaesthesia for Emergency Surgery

“…Pender (1954) advocates particular care with patients who have been on cortisone treatment for a period of three to six months preceding surgery and anaesthesia, especially in the case of those who have exhibited marked reactions such as hypertension, hirsutism or peripheral oedema. In such cases there occurs some degree of adreno‐cortical atrophy, and fatalities after quite trivial operations have been reported (Fraser, Preuss, Bigford, 1952; Lundy, 1953). It is suggested that the administration of exogenous cortisone suppresses the release of ACTH, and the adrenal cortex, from lack of stimulus, gradually undergoes a type of disuse atrophy.…”

Adrenocortical Insufficiency During Surgical Anesthesia

“…In this presentation, the following points will be considered: (1) basic concepts of adrenocortical function ; (2) the modifying role of anesthesia ; ( 3 ) behavior during relatively minor surgical operations of patients with adrenocortical insufficiency who are not receiving adrenocortical steroid therapy ; (4) behavior during major surgical interventions of patients with adrenocortical insufficiency supported by adequate hormonal therapy ; ( 5 behavior of patients during major surgery resulting in adrenocortical insufficiency.…”