Table 2 Group-specific responses of anesthesiologists and pediatric endocrinologists regarding perioperative care of pediatric congenital adrenal hyperplasia patients
From: Perioperative care of congenital adrenal hyperplasia – a disparity of physician practices in Canada
Anesthesiologists n = 48 | Endocrinologists n = 37 | |
|---|---|---|
Congenital adrenal hyperplasia in practice, n (%) | ||
Number of CAH patients in endocrinology practice | ||
None | 2 (5.4) | |
1–5 | 16 (43.2) | |
6–10 | 8 (21.6) | |
11–15 | 4 (10.8) | |
> 15 | 7 (18.9) | |
Number of pediatric CAH patients in anesthesia practice per year | ||
≤ 5 | 44 (91.7) | |
6–12 | 4 (8.3) | |
Percentage of practice that involves pediatric anesthesia | ||
1–25 | 3 (6.2) | |
26–50 | 5 (10.4) | |
51–75 | 5 (10.4) | |
76–100 | 35 (72.9) | |
Pediatric congenital adrenal hyperplasia management, n (%) | ||
Common to see CAH patients regarding stress dose prior to surgery | ||
Yes | 34 (91.9) | |
Sometimes | 3 (8.1) | |
Consult another anesthesiologist regarding stress dosing | ||
Frequently (> 50% of the time) | 3 (6.3) | |
Occasionally (< 50% of the time) | 15 (31.3) | |
Never | 30 (62.5) | |
Frequency of consult to anesthesiologist regarding stress dose | ||
Always | 6 (16.2) | |
Frequently | 6 (16.2) | |
Occasionally | 11 (29.7) | |
Never | 14 (37.8) | |
Frequency of consult to endocrinologist regarding stress dose | ||
Always | 14 (28.6) | |
Frequently | 12 (24.5) | |
Occasionally | 14 (28.6) | |
Never | 9 (18.4) | |
Endocrinology referral common at home institution for any surgery in children with CAH | ||
Yes | 42 (89.4) | |
Unsure | 5 (10.6) | |
Recommend corticosteroid stress dose for children with CAH undergoing anesthesia | ||
Always | 21 (56.8) | |
Severity dependent | 5 (13.5) | |
Procedure dependent | 5 (13.5) | |
Severity and procedure dependent | 6 (16.2) | |
Minor procedure recommendation/management (e.g. cystoscopy), n (%) | ||
Recommended dosing: | ||
Mild stress dosing (20–40 mg/m2 of HC equivalent) | 26 (70.3) | |
High dose (50–100 mg/m2 of HC equivalent) | 8 (21.6) | |
Baseline therapy | 3 (8.1) | |
Follow guidelines for minor procedures? | ||
Yes | 21 (44.7) | |
No | 26 (55.3) | |
Steroid dosing if typically using dexamethasone for prevention of PONV | ||
Omit dexamethasone, give stress dose | 23 (48.9) | |
Give dexamethasone + baseline steroid | 12 (25.5) | |
Give dexamethasone + stress dose | 6 (12.8) | |
Other | 6 (12.8) | |
Major procedure management (e.g. laparotomy), n (%) | ||
Follow guidelines | ||
Yes | 37 (78.7) | |
No | 10 (21.3) | |