10. STEROID SUPPLEMENTATION

Patients on long term or recently ceased steroid therapy may require increased doses of glucocorticoids during the stress of illness and surgery. Acute adrenal insufficiency may result in cardiovascular collapse and death.

The benefit of steroid supplement must be weighed against the risk.

Perioperative steroid supplementation may cause immunosuppression, delayed wound healing, hyperglycaemia and sodium and water retention.

Patients receiving steroids should continue the steroid treatment.

Recommendation

If the normal prednisolone dose is less than 10 mg/day then give only the patient’s usual steroid treatment. No extra steroid cover is required.

If the normal prednisolone dose is greater than 10 mg/day,

for minor surgery give the patient’s usual dose plus 25 mg of  hydrocortisone at the

start of the anaesthetic 

for moderate surgery give the patient’s usual dose plus 25 mg of hydrocortisone at the

start of the anaesthetic and 100 mg of hydrocortisone over the next 24 hours

for major surgery give the patient’s usual dose plus 25 mg of hydrocortisone at the

start of the anaesthetic and 100 mg of hydrocortisone/day for 2days

Patients who have ceased receiving long-term steroids may still need to receive steroids supplements.

Recommendation

If steroid treatment was ceased less than 3 months ago then treat the patient as if they were still taking steroids for moderate and major surgery only.

If steroid treatment was ceased more than 3 months ago then no perioperative steroids are indicated.

 [Dexamethasone 1 mg = prednisolone 5 mg = hydrocortisone 20 mg]