Management of glucocorticoids during the peri-operative period

Question 1

Adrenal insufficiency

Answer 1

• Can be caused by patients taking any steroid (>5m/kg pred equivalent) via any route
• All steroid-dependent patients are at risk of an adrenal crisis

Question 2

Steroid cover for steroid-dependent patients having minor/ moderate surgery, labour or c-section

Answer 2

Intra-op
- Hydrocortisone 100mg IV on induction
- Followed by a continuous infusion of 200mg/24hr

Post-op
- Continue infusion while patient is NBM
- When E&D 2x normal steroid dose for 48hrs-1week

Question 3

Steroid cover for paediatric steroid-dependent patients having surgery

Answer 3

Major
- Induction hydrocortisone 2mg/kg
- Followed by continuous infusion based on weight
- 2x dose when E&D

Minor
- Induction hydrocortisone 2mg/kg
- No need for infusion
- 2x normal dose for 24 hours

Question 4

Steroid Equivalents
Hydrocortisone: Prednisolone: Dexamethasone

Answer 4

Hydrocortisone 10mg: Prednisolone 2mg: Dexamethasone 0.1mg