CORTISONE OR CORTICOTROPIN FOR ASTHMATIC PATIENTS WHO REQUIRE MAJOR SURGICAL PROCEDURES

IT IS NECESSARY to delay most major surgical procedures for patients who have asthma until the patient's cough, paroxysmal dyspnea and orthopnea are well controlled. This is particularly important in surgical procedures directed to the thoracic, renal and upper abdominal areas, in which splinting of the diaphragm commonly occurs postoperatively.¹ Usually, but not always, a preliminary period of hospitalization with symptomatic treatment and appropriate attention to any existing complications of asthma suffices to get the patient ready for the needed operation. However, we have recently encountered difficulty in bringing asthma under control within a reasonable period in four patients who needed surgical attention. In one patient who had colic from gallstones while she was receiving preoperative treatment of her asthma, cortisone brought about prompt remission of the asthma, which permitted successful and uncomplicated cholecystectomy. For a second patient who had a large incarcerated umbilical hernia, corticotropin (ACTH) was resorted