SU1268171A1 - Method of prophylaxis of acute adrenocortical insufficiency in surgical operations - Google Patents

Abstract

The invention relates to medicine and can be used to prevent acute adrenocortical insufficiency in operations. The purpose of the invention is to reduce complications. Before the operation, clinical and laboratory examination is performed. In the case of withdrawal of steroids treatment 2-5 months prior to surgical treatment, hydrocortisone is administered once at 1 mg / kg before surgery. When signs of acute adrenocortical insufficiency appear, this drug is administered (L even during surgery. If steroid therapy is discontinued less than 2 months before surgery, hydrocortisone is administered before, during and after surgery.) During steroid therapy, hydrocortisone is administered once before the operation, 1 mg / kg. During the operation, 1-2 daily doses of the drug are administered and after the operation a 1-day dose of the drug.

Description

one

The invention relates to medicine and can be used in the anesthetic maintenance of operations in patients with inhibition of the function of the adrenal cortex. .

The purpose of the invention is to reduce complications.

Example 1. Ill S-va M.V. 13 years old. case history No. 750523, diagnosis: rheumatoid arthritis, articular-visceral form. The patient held arthroplasty of the right knee joint. Duration of surgery 2 h 5 min. Before the operation, courses of steroid therapy with high doses of glucocorticoids regularly relieved for 5-6 years. 3 months prior to the operation, glucocorticoids were canceled without increasing the activity of the process and worsening the patient's state of health. Clinical and laboratory examinations before the operation revealed signs of insufficiency of the adrenal cortex. 1-3 days before surgery, glucocorticoids were not prescribed. 2 h before the operation, hydrocortisone was intramuscularly injected at a dose of 1 mg / kg body weight. During the operation and the first 18–20 hours, a wait-and-see tactic was applied. During the entire indicated period, hemodynamic parameters in the patient were stably kept at the level of 110120/70 mm Hg, the frequency of cardiac contractions was 90-108 beats / min, which made it possible not to introduce additional. glucocorticoids. The patient had no increased tissue bleeding during the operation, blood loss was 9% of the estimated circulating blood volume (BCC), and no other adverse events or complications associated with the administration of glucocorticoids for the prevention of acute adrenocortical insufficiency were noted.

Example 2. Patient X-cue V. A 13 years old, case history No. 760076, diagnosed with rheumatoid arthritis, the joint is of the no-visceral form. The patient made sinovatsuectomy. right knee joint. Duration of surgery 2 h 40 min. Before the operation, within 3 years, as part of a comprehensive medical treatment, he received courses of steroid drugs in significant doses (up to 40 mg of prednisolone per day). The last course of steroid therapy was completed 5 months before the operative1D1I. Clinical and laboratory examination of the patient before the operation did not reveal signs of insufficiency of the adrenal cortex function. 1-2 days before surgery, glucocorticoids were not prescribed. 2 h before the operation, hydrocortisone was intramuscularly injected at a dose of I mg / kg body weight. A wait-and-see tactic was applied during the operation. Hemodynamic parameters before introduction into general anesthesia and during the first half of the operation were stably maintained at a normal level: blood pressure within I 10115/60 mm Hg, heart rate 92-96 beats / min. In the middle of the operation, after removing the harness, the blood pressure decreased to 90/40 mm Hg, the tachycardia increased. Intravenously, 25 mg of hydrocortisone (0.6 mg / kg body weight) was administered intravenously, after which the blood pressure and pulse rate returned to normal. The further course of the operation and anesthesia, as well as the immediate postoperative period, is smooth. The patient had no increased bleeding of tissues, hemorrhage was 21% of the calculated BCC, there were no complications that could be associated with the administration of glucocorticoids.

Example 3. Patient Sh-ska VA, 9 years old, case history No. 761384, diagnosis: rheumatoid arthritis, predominantly articular form. The patient produced synovovpsuectomy and of the right knee joint. Duration of surgery 2 h 40 min. For 6 years, as part of complex drug treatment, the patient repeatedly received courses of steroid therapy in high doses. During the year prior to surgery, glucocorticoids received irregularly. The last two months of steroid therapy have not been performed. Clinical and laboratory examination of the patient before the operation did not reveal signs of insufficiency of the adrenal cortex function. 1-3 days before the operation, glucocorticoids were not prescribed. 2 h before the operation, hydrocortisone was administered intramuscularly at a dose of 1 mg / kg of body weight, then hydrocortisone was intramuscularly infused into the total

Claims (1)

The claims ₃ A method for the prevention of acute adrenocortical insufficiency during surgical operations in patients undergoing steroid therapy before surgery, by fractional parenteral administration of hydrocortis- ⁵ zone before, during and after surgery, characterized in that, in order to reduce complications, hydrocortisone is administered a single dose of 1 mg / kg, and if steroid therapy is canceled 2-5 months before surgical treatment, the drug is administered before surgery, and if signs of acute adrenocortical insufficiency appear operation time, 'in case of cancellation of steroid therapy in less than 2 months prior to surgery hydrocortisone is administered before, during and after surgery in the case of continuing steroid cho ¹ rapii carried administering a single dose of I mg / kg to operation odnoydvuh preoperative daily doses in the time and one daily dose of the preparation after surgery. Circulation 660 ________ Signed. Uzhhorod, st. Project, 4