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Steroid Management
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. |
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 |