Principle of surgery
Types of Insulin
exists in any person with diabetes, consideration should be given to hospital admission to allow for acute control of the hyperglycemia and aggressive management of the infection. Many clinicians also believe that prophylactic antibiotics should be given routinely to patients with diabetes
undergoing any, surgical procedure. However, this position is controversial (Box 1-19).
Adrenal insufficiency. Diseases of the adrenal cortex may cause adrenal insufficiency. Symptoms of primary adrenal insufficiency include weakness, weight loss, fatigue, and hyperpigmentation of skin and mucous
membranes. However, the most common cause of adrenal insufficienty is chronic therapeutic corticosteroid administration (secondary adrenal insufficiency): Often patients regularly taking corticosteroids have moon
facies,buffalo humps,” and thin, translucent skin. Their inability to increase endogenous corticosteroid levels in response to physiologic stress may cause them to become hypotensive, syncopal, nauseated, and feverish during complex, prolonged surgery.
If a patient with primary or secondary adrenal supressing requires complex oral surgery, the primary care physician should be consulted regarding the’ potential need for supplemental steroids. In general, minor procedures require only the use of an anxiety reduction protocol. Thus supplemental steroids are no~, needed for most dental procedures. However more complicated procedures, such as orthognathic surgery
in an adrenaily suppressed patient, usually require steroid supplementation by administration of double the usual steroid dose just before the surgery or by administration of 60 mg of hydrocortisone presurgically, with a decrease of the amount to 40 mg the first 2 days after surgery, 20 mg the next 3 days, and the usual dose thereafter (Box 1-20),: ‘
Hyperthyroidism. The thyroid problem of primary Significance in oral surgery is thyrotoxicosis, became it is the only thyroid disease in which an acute crisis can, occur. Thyrotoxicosis is the result of an excess of circulating triiodothyronine (T3) and thyronine (T4), which is caused most frequently by Graves disease, a multinodu