Читать книгу Management of Complications in Oral and Maxillofacial Surgery - Группа авторов - Страница 42

Adrenal crisis is a rare but serious complication of suppressed adrenal release of cortisol and can rapidly cause hemodynamic collapse if the cortisol deficiency is not promptly diagnosed and rectified. Risk factors for acute adrenal crisis include both patient and procedure factors. Surgical procedures that are invasive and cause high levels of physiological stress carry the highest risk. Patients most at risk for adrenal crisis are typically those with a lengthy history of moderate‐ to high‐dose exogenous corticosteroid supplementation, though adrenal crisis has been classically associated with Addison's disease (primary adrenocortical insufficiency). Since most procedures that will be performed in an outpatient setting will be minimally invasive and of short duration, the risk of adrenal crisis is low. Patients should be screened for a history of Addison's disease or corticosteroid use, and preoperative adjunctive corticosteroid supplementation should be considered for any patient deemed to be at risk. Acutely, the management of adrenal crisis involves IV cortisol administration and supportive measures.