(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

Useful Link:

Management of Glucocorticoids During the Peri-operative Period for Patients with Adrenal Insufficiency. Anaesthesia, 2020