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Post by emedina1 on Nov 18, 2019 20:30:34 GMT -5
In my practice previously doing different kinds of cases, I always discuss with the attending the relevance of the stress dose . As previously mentioned it has gotten out of practice. once in a while in Wilmer, I come along with an attending who is very intense I was told to give a stress dose. I have seen a slight difference in the BP of one patient. was it a coincidence or was it really needed. I was happy idid.
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Post by aileenm4 on Nov 19, 2019 17:26:46 GMT -5
good article to discuss what has been a trend which is to be thoughtful about each individual patients steriod needs, current dose, duration and stress level for OR. We used to years ago give 100 mg preop, 100mg intraop and 100 mg postop to everyone. Now I reach out to the patients endocrine team and discuss recommendations with them or usually in peds there is a note written with their recommendations. I recently cared for a child with Prader Willi syndrome who was on chronic steroids. He had significant hypotension intraoperatively and it as resolved with giving him (more than the endocrine recommended Steroid dose ). I will continue to give steroids as discussed with the team, the level of stress, last dose and how the patient responds during the procedure.
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Post by Chuck Eder on Nov 19, 2019 22:48:31 GMT -5
My current practice is to stress dose the patient with 50-100 mg hydrocortisone if the patient has not taken their daily dose. Like others have mentioned already, I haven't witnessed the hypotension from adrenal insufficiency. I will continue to stress dose patients that are on chronic steroids. Their current dose, duration of steroid therapy, and type of surgery will help guide my treatment.
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Post by Jennifer Hannon on Nov 20, 2019 10:16:19 GMT -5
I usually administer a stress dose after discussing with the entire team to determine whether a stress dose is necessary.
I have not experienced hypotension attributed to adrenal insufficiency. Steroids are wonderful drugs when use appropriately, especially for poison ivy too!
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