Intra-operative steroid replacement | Postoperative steroid replacement | |
---|---|---|
Major surgery | Hydrocortisone 100 mg intravenously at induction, followed by immediate initiation of a continuous infusion of hydrocortisone at 200 mg.24 h-1 Alternatively, hydrocortisone 50 mg im 6-hourly Alternatively, dexamethasone 6–8 mg intravenously, if used, will suffice for 24 h | Hydrocortisone 200 mg.24 h-1 by intravenous infusion while nil by mouth. Alternatively, hydrocortisone 50 mg im 6-hourly Resume enteral glucocorticoid at pre-surgical therapeutic dose if recovery is uncomplicated. Otherwise continue double oral dose for 48 h |
Body surface and intermediate surgery | Hydrocortisone 100 mg, intravenously at induction, followed by immediate initiation of a continuous infusion of hydrocortisone 200 mg.24 h-1 Alternatively, hydrocortisone 50 mg im 6-hourly Alternatively, dexamethasone 6–8 mg intravenously, if used, will suffice for 24 h | Double regular glucocorticoid dose for 48 h, then continue usual treatment dose |
Bowel procedures requiring laxatives/enema | Continue normal glucocorticoid dose. Equivalent intravenous dose if prolonged nil by mouth. Treat as per primary adrenal insufficiency (see above) if concerned about HPA axis function, and risk of adrenal insufficiency | |
Labour and vaginal delivery | Hydrocortisone 100 mg intravenously at onset of labour, followed by immediate initiation of a continuous infusion of hydrocortisone 200 mg.24 h-1 Alternatively, hydrocortisone 100 mg intramuscularly followed by 50 mg every 6 h im | |
Caesarean section | See major surgery |
In severe obesity consider substituting 50 mg hydrocortisone with 100 mg hydrocortisone. While it is recommended hydrocortisone 50 mg every 6 h is given im, hydrocortisone can be given iv if patients are anticoagulated or clinically indicated.