Care of surgical patient on Steroids

Question 1

What are patients on steroids at risk of during surgery and why?

Answer 1

• Addisonian crisis

- Exogenous steroids cause HPA axis suppression, surgical stress causes an increase in cortisol secretion.

Question 2

Who is likely to produce HPA axis suppression?

Answer 2

• Receive high doses (over 20-30mg prednisolone or equivalent)
• Systemic steroids for long periods (>3weeks)
• Cushingoid features

Question 3

What is given to patients who are NMB during surgery who are normally on exogenous steroids?

Answer 3

IV hydrocortisone qds

‘Stress dose corticosteroid therapy’

Question 4

What should be monitored post operatively?

Answer 4

• Blood pressure

- Electrolytes (Na+ and K+)

Question 5

What should be given when a patient is NMB?

Answer 5

0. 9% saline
   - Prevent dehydration
   - Ensure mineralocorticoid stability

Question 6

What is the conversion of prednisolone to hydrocortisone IV?

Answer 6

5mg PO prednisolone = 20mg hydrocortisone IV