(Originally presented by Dr Andrew Inglis)
Overview
- Taking ≥ 5 mg prednisone daily for ≥ 1 month are at risk
- New guidelines conservative
- Limited evidence of long-term problems related to peri-operative steroid administration
Suggested Regime
- Hydrocortisone 100 mg IV bolus at induction
- Followed by continuous infusion of hydrocortisone 200 mg/24 hours
- until patient tolerating oral medication
- Patients should then double their regular oral dosage
- Wean back to regular dose over 2-7 days
- depending upon severity of surgery and complications
Alternatively (perhaps well suited for daycare procedures)
- 8 mg dexamethasone (provides 24-hour coverage)
- no mineralocorticoid activity so not appropriate for primary adrenal insufficiency