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Steroid Management
The UK Addison’s Clinical Advisory Panel Provides Updated guidelines on Perioperative management of adrenal insufficiency.
Steroid Cover for Chronic Steroid Related Adrenal Insufficiency
Steroid Cover for Chronic Steroid Related Adrenal Insufficiency1
Prescribed glucocorticoid therapy (prednisolone ≥ 5 mg.day-1 in adults or hydrocortisone-equivalent dose of 10–15mg.m-2 per day in children) across all routes of administration (oral, inhaled, topical, intranasal, intra-articular), can cause suppression of the hypothalamo–pituitary–adrenal axis, and is the most common cause of adrenal insufficiency that anaesthetists will encounter.
Glucorticoid-dependent patients are at risk of adrenal crisis as a consequence of surgical stress or illness, and should be given supplementary steroids as per the following table.
Intraoperative |
Postoperative |
|
Major Surgery inc LUSCS |
IV Hydrocortisone 100mg at Induction. |
Hydrocortisone 100 mg.24hrs-1 by IV infusion while NBM |
Body Surface and Intermediate Surgery |
Double regular glucocorticoid dose for 48hr |
|
Bowel Prep |
Continue usual Glucocorticoid Dose. Convert to IV if NBM. |
|
Labour and Vaginal Delivery |
IV Hydrocortisone 100mg at Onset of Labour. |
Same table formated for phone below
Major Surgery inc LUSCS |
|
Intraoperative |
IV Hydrocortisone 100mg at Induction. |
Postoperative |
Hydrocortisone 100 mg.24hrs-1 by IV infusion while NBM |
Body Surface and Intermediate Surgery |
|
Intraoperative |
IV Hydrocortisone 100mg at Induction. |
Postoperative |
Double regular glucocorticoid dose for 48hr |
Bowel Prep |
|
Intraoperative |
Continue usual Glucocorticoid Dose. Convert to IV if NBM. |
Postoperative |
|
Labour and Vaginal Delivery |
|
Intraoperative |
IV Hydrocortisone 100mg at Onset of Labour. |
Postoperative |