PERIOPERATIVE STEROID REPLACEMENT THERAPY

1. <10mg prednisolone Assume normal No additional steroid cover

/ day HPA axis required
2. >10mg prednisolone Minor surgery, Routine preoperative steroid or
/ day e.g. hernia hydrocortisone 25mg IV at
induction
Intermediate surgery, Routine preoperative steroid
e.g. hysterectomy plus hydrocortisone 25mg IV at
induction, and then 6-hourly for
24hr
Major surgery, Routine preoperative steroid
e.g. cardiac plus hydrocortisone 25mg IV at
induction, then 6-hourly for 48–
72hr
5. High-dose Should continue usual immunosuppressive dose until
immunosuppression able to revert to normal oral intake, e.g. 60mg
prednisolone/24hr = 240mg hydrocortisone/24hr
6. Patient formerly <3 months since stopped steroids—treat as if on steroids
taking regular >3 months since stopped steroids—no perioperative
steroids steroids necessary