32. Perioperative Stress and Corticoid Supplementation Quiz

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Which group had the highest death rate in the study?

Subphysiologic replacement group (correct)

Supraphysiologic replacement group

Physiologic replacement group

Sham-operated control group

What was the cause of death in the subphysiologic replacement group?

Tachycardia

Severe hypotension (correct)

Hypovolemia

Severe congestive heart failure

What was the effect of glucocorticoids and catecholamines on cardiac contractility and vascular tone?

No effect on cardiac contractility and vascular tone

Increased cardiac contractility and vascular tone (correct)

Unpredictable effects on cardiac contractility and vascular tone

Decreased cardiac contractility and vascular tone

What was the capacity for wound healing in all treatment groups?

Same capacity for wound healing Signup and view all the answers

What did the study confirm about inadequate corticosteroid coverage?

It can cause death Signup and view all the answers

What did the Cochrane Systemic Review conclude about the use of supplemental perioperative steroids for patients with adrenal insufficiency during surgery?

There is insufficient evidence to support or refute their use Signup and view all the answers

What is a sensitive test of pituitary-adrenal competence?

Measuring plasma cortisol concentration during acute stress Signup and view all the answers

What increase in plasma cortisol indicates normal pituitary-adrenal responsiveness in the synthetic ACTH test?

6 to 20 μg/dL Signup and view all the answers

What is the daily secretion range of cortisol by the adrenal glands under perioperative conditions?

116 to 185 mg Signup and view all the answers

What was the mean maximal concentration of cortisol in plasma during major surgery?

47 μg/dL Signup and view all the answers

Which of the following statements is true about perioperative stress and corticoid supplementation?

Longer duration and higher home steroid dose decrease the likelihood of glucocorticoid deficiency. Signup and view all the answers

What is the main cause of perioperative cardiovascular problems in patients with suppressed adrenal function?

Lack of supplemental steroids Signup and view all the answers

Which of the following is true about glucocorticoid or mineralocorticoid deficiency in patients taking steroids on a long-term basis?

It rarely occurs. Signup and view all the answers

What is the risk of giving patients steroid coverage equivalent to 100 mg of hydrocortisone perioperatively?

It has no risk. Signup and view all the answers

What does the study on glucocorticoid replacement in nonhuman primates reveal about inadequate perioperative corticosteroid replacement?

It is associated with life-threatening events. Signup and view all the answers

What were the doses of cortisol given to the adrenalectomized primates and sham-operated controls in the study?

Subphysiologic, physiologic, and supraphysiologic doses Signup and view all the answers

What was the duration of steroid administration in the study on glucocorticoid replacement in nonhuman primates?

4 months Signup and view all the answers

What procedure did the primates undergo in the study on glucocorticoid replacement?

Abdominal surgery Signup and view all the answers

What was the outcome for the group given subphysiologic doses of steroid perioperatively in the study?

Increased mortality Signup and view all the answers

What is the main factor that delays the usual intraoperative glucocorticoid surge to the postoperative period?

Degree of trauma Signup and view all the answers

Which of the following is the maximum amount of glucocorticoid that is usually intravenously administered in response to maximal stress?

200 mg/day of hydrocortisone Signup and view all the answers

For minor surgical procedures, how much hydrocortisone is usually intravenously given per day?

50 to 100 mg/day Signup and view all the answers

For major surgical procedures, how often is hydrocortisone usually given intravenously?

Every 8 hours Signup and view all the answers

What are the risks of perioperative steroid supplementation?

Aggravation of hypertension, fluid retention, inducement of stress ulcers, and psychiatric disturbances Signup and view all the answers

What is the effect of short-term perioperative supplementation with glucocorticoids on wound healing?

It has a small but definite deleterious effect on wound healing Signup and view all the answers

Is there an increased risk of serious infections with long-term use of steroids alone?

No, there is no increased risk of serious infections Signup and view all the answers

What is the effect of aging on adrenal cortex function in older adults?

Plasma levels of cortisol decrease Signup and view all the answers

How does aging affect the ability to metabolize and excrete glucocorticoids?

The ability is reduced Signup and view all the answers

What is the most common cause of spontaneous Cushing disease in patients older than 60 years?

Adrenal carcinoma Signup and view all the answers

Is the rate of cortisol secretion slower in older adults?

Yes, the rate of cortisol secretion is slower Signup and view all the answers