Perioperative Corticosteroid

Indication: Acute severe illness (critically ill such as Septic Shock)
1. Serum Cortisol <15 to 34 mcg/dl
2. Cortisol <9 after Corticotropin Stimulation Test
Management
1. Hydrocortisone
  1. Adults: 50 mg IV or IM q6 hours (or 3x the chronic dose)
  2. Children: 1 to 2 mg/kg IV every 8 hours
2. Consider adding fludricortisone 50 mcg daily for 7 days
3. Taper stress dosing over 10-14 days

Indications: Primary or secondary Adrenal Insufficiency
1. Hypothalamic pituitary axis suppression with chronic Corticosteroids within 3-12 months of surgery
  1. Predisone 20 mg for at least 3 weeks or
  2. Prednisone 5 mg daily longterm
Minor procedure not requiring sedation (doses for day of surgery)
1. Hydrocortisone 25 mg IV or
2. Methylprednisolone 5 mg IV
Moderate procedure requiring sedation
1. Initial (day of surgery)
  1. Hydrocortisone 50-75 mg IV or
  2. Methylprednisolone 10-15 mg IV
2. Next
  1. Hydrocortisone 25 mg IV every 8 hours for 24 to 48 hours
  2. Methylprednisolone tapered over 1-2 days
High Risk Surgery
1. Initial (day of surgery)
  1. Hydrocortisone 100-150 mg IV or
  2. Methylprednisolone 20-30 mg IV
2. Next
  1. Hydrocortisone 50 mg IV every 8 hours for 24 to 48 hours or
  2. Methylprednisolone tapered over 1-3 days