I was taught the following (first reference):
- Methylprednisone (Solu-Medrol) 20 mg IM on call to surgery
- During surgery infuse hyprocortisone (Solu-Cortef) 100 mg IV over 8 hr
- Day of surgery: hydrocortisone 50-100 mg IV every 8 hr
- POD #1: hydrocortisone 25-50 mg IV every 8 hr
- POD #2: hydrocortisone 25 mg IV every 8-12 hr
- Thereafter: Resume maintenance steroid dose if there are no complications which prolong stressful period, for example, infection.
- Methylprednisolone 20 mg IM on call to surgery
- During surgery infuse hydrocortisone 50 mg IV over 4 hr
- Evening of surgery give double usual daily dose of prednisone
- POD #1: Resume maintenance therapy
- IV fluids should contain saline
I was pleasantly surprised to see that a fellow blogger, Notes from Dr. RW, recently posted on just this subject. He covered the subject from the hospitalist point-of-view. Here is his summary of current recommendations:
Minor procedure (endoscopy, inguinal hernia repair):
- 25 mg hydrocortisone or its equivalent on day of procedure only.
Moderate procedure (abdominal surgery):
- 50-75mg hydrocortisone on day of procedure and taper quickly over 2-3 days to patient’s maintenance dose.
High risk procedure (cardiovascular surgery, extensive abdominal):
- 100-150 mg hydrocortisone initially, then taper over 1-2 days to patient’s maintenance dose.
It is important for all of us (surgeons, anesthesiologist, internist, etc) to remember how long term use of prednisone can affect patients.
Hand Clinics--Rheumatoid Arthritis; chief editor Paul Feldon, MD; May 1989;page 119
Perioperative Management of the Rheumatic Disease Patient; Joe T. Kelley III, MD, Doyt L. Conn, MD; Bulletin on the Rheumatic Diseases, Vol 51, No 6 (free access on-line)
Corticosteroid Supplementation for Adrenal Insufficiency; Douglas B. Coursin, MD; Kenneth E. Wood, DO ; JAMA, 2002;287:236-240
What is Adrenal Insufficiency?--EndocrineSurgeon