Understanding Anesthesiology - The Global Regional Anesthesia ...

current recommendations from the American Heart Association
are much more restrictive than they have
been in the past.
As discussed, aspiration prophylaxis may be ordered in
high risk patients. This includes agents which decrease
the volume and/or acidity of gastric secretions (ranitidine,
sodium citrate) as well as agents which increase
gastric emptying (metoclopramide).
A history of systemic steroid use may require the delivery
of a peri-operative course of steroids in order to
avoid the consequences of adrenal suppression which
may present as an Addisonian crisis. Adrenal suppression
occurs when a patient receives longterm exogenous
steroids in daily dose equal to or greater than 10
mg. Once adrenal suppression has occurred, the adrenal
gland takes approximately 3 months to recover
function (after steroid discontinuation). Therefore, steroid
supplementation is required for patients who are
currently on exogenous steroids or have discontinued a
longterm course in the past three months. The amount
and duration of supplemental steroid coverage required
depends on the invasiveness of the surgery. For
minor surgery, a single dose of hydrocortisone (25 mg)
suffices, while for major surgery, the patient requires
100 mg of hydrocortisone daily for 2-3 days.
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