Corticosteroid coverage for surgery in patients taking exogenous corticosteroids

For minor procedures or surgery under local anesthesia (eg, inguinal hernia repair), take usual morning steroid dose. No extra supplementation is necessary.

For moderate surgical stress (eg, lower extremity revascularization, total joint replacement), take usual morning steroid dose. Give 50 mg hydrocortisone intravenously just before the procedure and 25 mg of hydrocortisone every eight hours for 24 hours. Resume usual dose thereafter.

For major surgical stress (eg, esophagogastrectomy, total proctocolectomy, open heart surgery), take usual morning steroid dose. Give 100 mg of intravenous hydrocortisone before induction of anesthesia and 50 mg every eight hours for 24 hours. Taper dose by half per day to maintenance level.

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Corticosteroid coverage for surgery in patients taking exogenous corticosteroids