TREATMENT OF ADRENAL CORTICAL INSUFFICIENCY DURING SURGICAL PROCEDURES

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Abstract
• Persistent hypotension during surgery, with failure to respond to adequate blood replacement and vasoconstrictors, respiratory depression, and a prolonged reaction time after anesthesia, is interpreted as the manifestation of adrenal cortical insufficiency. It is to be anticipated in patients who have been chronically ill, who have disease involving the adrenals, or who have undergone adrenalectomy. The logical treatment, if the condition develops during surgery, is the intravenous administration of hydrocortisone. This steroid has the advantage of rapidity of action. Its effects were strikingly exemplified in seven cases here described, involving patients enfeebled by severe illness or predisposed to irreversible shock for other reasons. Patients whose blood pressure had gone too low to measure and whose pulse became impossible to count responded promptly to hydrocortisone and recovered from the anesthesia without further difficulty. These results suggest that the basic physiological disturbance was a deficiency of adrenal ccrtical secretion.

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