What should be included in preoperative orders for a patient with adrenal insufficiency undergoing surgery?

In a patient with adrenal insufficiency, especially when undergoing surgery, it is crucial to ensure that they receive adequate glucocorticoid replacement therapy to prevent an adrenal crisis. During times of stress, such as surgery, the demand for corticosteroids increases, and patients with adrenal insufficiency are unable to produce these hormones in response to such stress.

Administering hydrocortisone intravenously every 8 hours is the standard approach in the perioperative setting for these patients. This method closely mimics the body's natural cortisol secretion and ensures that the patient has sufficient cortisol levels to manage the physiological stress of the surgical procedure. Hydrocortisone is preferred in this setting due to its short half-life and ease of administration.

Other options, like regular oral corticosteroids, may not adequately address the acute needs of a patient during surgery, as oral medications may not be absorbed effectively due to fasting or the altered physiological state during surgery. Dexamethasone, while a corticosteroid, is generally not the first choice during surgery for adrenal insufficiency and is usually reserved for specific conditions due to its longer duration of action and potential side effects. The notion that no special orders are needed disregards the critical importance of maintaining adequate corticosteroid levels in these patients to