Surgery

Perioperative Corticosteroid

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Perioperative Corticosteroid, Stress Dose Steroid

  • Protocol
  • Stress Dose Steroid
  1. Indication: Acute severe illness (critically ill such as Septic Shock)
    1. Serum Cortisol <15 to 34 mcg/dl
    2. Cortisol <9 after Corticotropin Stimulation Test
  2. Management
    1. Hydrocortisone 50 mg IV or IM q6 hours
    2. Consider adding fludricortisone 50 mcg daily for 7 days
  • Protocol
  • Perioperative Corticosteroids
  1. Indications: Primary or secondary Adrenal Insufficiency
    1. Hypothalamic pituitary axis suppression with chronic Corticosteroids within 3-12 months of surgery
      1. Predisone 20 mg for at least 3 weeks or
      2. Prednisone 5 mg daily longterm
  2. Minor procedure not requiring sedation (doses for day of surgery)
    1. Hydrocortisone 25 mg IV or
    2. Methylprednisolone 5 mg IV
  3. Moderate procedure requiring sedation
    1. Initial (day of surgery)
      1. Hydrocortisone 50-75 mg IV or
      2. Methylprednisolone 10-15 mg IV
    2. Next
      1. Hydrocortisone 25 mg IV every 8 hours for 24 to 48 hours
      2. Methylprednisolone tapered over 1-2 days
  4. High Risk Surgery
    1. Initial (day of surgery)
      1. Hydrocortisone 100-150 mg IV or
      2. Methylprednisolone 20-30 mg IV
    2. Next
      1. Hydrocortisone 50 mg IV every 8 hours for 24 to 48 hours or
      2. Methylprednisolone tapered over 1-3 days
  • References
  1. Dummer (2009) Perioperative Guidelines
  2. Fraboni (2012) Board Review Express, San Jose
  3. Coursin (2002) JAMA 287(2):236-40 [PubMed]