Post operative Steroid therapy

The correct option Answer: a

The postoperative course of management for a patient with pituitary adrenal suppression from exogenous steroids involves tapering the exogenous steroid doses to maintenance levels after high dose replacement at the time of operation. One simple regimen involves administering 100 mg of hydrocortisone intravenously every 6 hours during the first 48 hours. Some prefer alternating doses of IM cortisone acetate in the event that intravenous access is lost. Provided that no intervening complications arise, the doses can be halved every 48 to 72 hours. In patients who have been exposed preoperatively to glucocorticoid excess, the maintenance dose may be as high as 100 mg/d for several months. Both high doses and normal maintenance of 35 to 55 mg/d can be given in the form of oral cortisone acetate as long as reliable alimentation and absorption have been achieved. The pituitary-adrenal axis remains suppressed for 6 to 12 months after operation. Complications in the postoperative period include wound infection, pancreatitis, and thromboembolism. There is no data to suggest that the risk of postoperative pancreatitis can be diminished with somatostatin analogue therapy.

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