Surgery
If a patient with adrenal insufficiency requires an elective procedure, ensure all relevant clinicians are aware of the need for increased glucocorticoid therapy.
For a minor procedure that does not require general anaesthetic, sedation or fasting (eg a skin lesion removal), consider using a double dose of the patient’s usual glucocorticoid on the morning of the procedure.
For a procedure that requires general anaesthetic, sedation or fasting, parenteral glucocorticoid therapy should be started at induction of anaesthesia or at the start of the procedure. Continue parenteral therapy until oral intake can be tolerated following the procedure.
For an adult, give:
hydrocortisone 100 mg intravenously, initially, then 50 mg intravenously, 6-hourly until oral therapy is tolerated. adrenal insufficiency, surgery (adult) hydrocortisone
For a neonate or child within the normal weight range for their age1, use:
hydrocortisone adrenal insufficiency, surgery (child) hydrocortisone
neonate or child up to 6 weeks: 25 mg intravenously, initially, then 5 to 10 mg intravenously, 6-hourly, until oral therapy is tolerated
child 6 weeks up to 3 years: 25 mg intravenously, initially, then 10 mg intravenously, 6-hourly, until oral therapy is tolerated
child 3 to 7 years: 50 mg intravenously, initially, then 12.5 mg intravenously, 6-hourly, until oral therapy is tolerated
child 7 to 12 years: 50 mg intravenously, initially, then 25 mg intravenously, 6-hourly, until oral therapy is tolerated.
For children outside the normal weight range for their age1, use:
hydrocortisone 50 to 75 mg/m2 intravenously, initially, then 12.5 to 18.75 mg/m2 intravenously, 6-hourly until oral therapy is tolerated2. adrenal insufficiency, surgery (child outside normal weight range) hydrocortisone
Higher doses may be needed in very sick children.
Once the patient is stable and tolerating oral intake, resume the usual oral glucocorticoid at the dose used for intercurrent illness. If the patient is recovering well, reduce the dose to the usual maintenance dose over 2 to 3 days.