A strategy for management of intraoperative Addisonian crisis during coronary artery bypass grafting
Open accessAbstract
Patients with Addison's disease undergoing cardiac surgery are at risk of developing a crisis. There is no consensus on the preoperative and intraoperative management of this group of patients undergoing cardiac surgery so the recommendations for non-cardiac patients are often used. The consensus statement from the international task force of the American College of Critical Care medicine recommends 100 mg of intravenous hydrocortisone for patients with adrenal insufficiency in septic shock, but in patients undergoing surgery, especially with extracorporeal circulation, the dosage may even be higher. We report our management of a patient with well-controlled adrenal insufficiency for 30 years who developed intraoperative Addisonian crisis despite the recommended preoperative corticosteroid supplementation. The importance of adequate corticosteroid supplementation for cardiac surgery patients, adapting the surgical strategy to allow for optimal management of potential complications and close monitoring with heightened awareness are discussed.
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Etomidate administration rapidly and powerfully suppresses cortisol production by inhibiting 11-beta-hydroxylase.
“Etomidate administration rapidly and powerfully suppresses cortisol production by inhibiting 11-betahydroxylase which catalyses the fi nal step in cortisol biosynthesis [27].”
From Guidelines for the management of glucocorticoids during the peri‐operative period for patients with adrenal insufficiency (2020) · cites this paper as [27]
The Case Report describes hydrocortisone given during anaesthesia induction, and the Discussion addresses corticosteroid supplementation for Addisonian crisis. Neither section discusses etomidate, 11-beta-hydroxylase, or inhibition of cortisol biosynthesis (searched for those terms and adrenal suppression). (LLM, conf=0.78)
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Adrenal function during coronary artery bypass grafting
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“Etomidate administration rapidly and powerfully suppresses cortisol production by inhibiting 11-betahydroxylase which catalyses the final step in cortisol biosynthesis [27].”
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Du bon usage des corticoïdes au bloc opératoire
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- Authors
- D'Silva, C., Watson, D., & Ngaage, D.
- Affiliations
- Blackpool Victoria Hospital (GB)
- Corresponding author
- Ngaage, D.
- ORCID
- Ngaage, D.
- Venue
- Interactive CardioVascular and Thoracic Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-01-22
- Volume
- 14
- Issue
- 4
- Pages
- 481-482
- ISSN
- 1569-9285 (ISSN-L)
- 1569-9293
- PMC
- PMC3309824
- OpenAlex
- W2151445981
- Cited by
- 5
- References
- 8
- Citations by year
- 2023: 1 · 2022: 1 · 2020: 2 · 2012: 1
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Interactive Cardiovascular and Thoracic Surgery (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- adrenal crisis, Addison's disease, adrenal insufficiency, coronary artery bypass grafting, intraoperative management, cortisol, corticosteroid supplementation, extracorporeal circulation, cardiac surgery
- MeSH terms
- Addison Disease, Coronary Artery Bypass, Glucocorticoids, Humans, Hydrocortisone, Male, Middle Aged, Preoperative Care, Risk Factors, Treatment Outcome, Coronary Stenosis
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