Episode 2: A Crisis of Adrenal Proportions

Episode Summary

In this episode of the APEX Live Anesthesia Podcast, we will briefly review the function of the hypothalamic-pituitary-adrenal axis, talk about glucocorticoids and mineralocorticoids, and discuss when to supplement and why. We’ll talk about the serious crisis that can occur when insufficient amounts of these hormones are available. We’ll finish by discussing what the evidence says about important topics related to steroids such as the best dose for PONV prophylaxis, should they be given for pain management, and if steroid administration perioperatively affects site infections or cancer recurrence.


What You'll Learn

  • What is the difference between glucocorticoids and mineralocorticoids, and which should I administer?
  • What does it mean to have acute adrenal insufficiency?
  • What is the best dose for PONV prophylaxis?
  • Does a single dose of steroid perioperatively affect site infection or cancer recurrence?


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Recommended Resources

  1. Bruder EA, Ball IM, Pickett W. 2015. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. doi 10.1002/14651858. 
  2. Awad K, et al. Dexamethasone combined with other antiemetics versus single antiemetics for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: An updated systematic review and meta-analysis. Int J Surg. 2016;28(4):152-163. 
  3. Zorilla-Vaca A. Dexamethasone injected perineurally is more effective than administration intravenously for peripheral nerve blocks: A meta-analysis of RCT’s. Clin J Pain. 2018;34(3):276-284.
  4. Sherif AA. Dexamethasone as Adjuvant for Femoral Nerve Block following Knee Arthroplasty: A Randomized, controlled study. Acta Anaesthesiol Scand. 2016; 60(7):977-87.
  5. De Oliveira GS. Dose ranging study of the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after gynecologic surgery. BJA. 2011;3, 362-371.
  6. Purushothaman A, et al. A prospective randomized study on the impact of low-dose dexamethasone on perioperative blood glucose concentrations in diabetics and nondiabetics. Saudi J Anesth. 2018;12(2): 198–203. 
  7. Assante J., et al. Infection Associated with Single-Dose Dexamethasone for Prevention of Postoperative Nausea and Vomiting: A Literature Review. AANA J. 2015;83(4):281-8.
  8. Polderman JA. Adverse side effects of dexamethasone in surgical patients. Cochrane Database Syst Rev. 2019;11. Doi 10.1002/14651858.


Legal Disclaimer

APEX Anesthesia Review, LLC and APEX Live expressly disclaim any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.

Podcast music by Eino Toivanen, kongano.com


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