Peri-operative steroid supplementation

Steroid treatment regimens

Patients currently taking steroids

< 10mg/day 
    Assume normal Hypothalamic-pituitary-adrenal response
    No additional steroid cover required

> 10mg/day
    Minor surgery
    25mg hydrocortisone at induction

    Moderate surgery
    Usual pre-op steroids + 25mg hydrocortisone at induction + 100mg/day for 24hrs

    Major surgery
    Usual pre-op steroids + 25mg hydrocortisone at induction + 100mg/day for 48-72hrs

Patients on high dose immunosuppression (eg transplant patients) should be given normal immunosuppressive doses during the perioperative period

Patients who have recently stopped taking steroids
    < 3 months 
    Treat as if on steroids

    > 3 months 
    No peri-operative steroids necessary 

NB Conversion for steroid doses

5mg Prednisolone equates to:

betamethasone 750mcg
dexamethasone 750mcg
hydrocortisone 20mg
methylprednisolone 4mg


Reference:

Nicholson, G et al
Peri-operative steroid supplementation
Anaesthesia, 1998; 53: 1091-1104