Cotton BA, Guillamondegui OD, Fleming SB, Carpenter RO, Patel SH, morris JA et al. Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients. Arch Surg 2008; 143(1):62-67. Table 1. Recommendations for Steroid Replacement Therapy (12) Indications Total Daily Dosage Duration Minor Surgical Stress Hydrocortisone Inguinal herniorrhaphy If procedure is uncomplicated, patient may • 10 mg IV Breast biopsy resume preoperative steroid dose on POD # 1 • q 8 hours Laparoscopic cholecystectomy • Moderate Surgical Stress Open cholecystectomy Hydrocortisone • If procedure is uncomplicated, patient may Fem-pop bypass 25 mg IV • resume preoperative steroid dose on POD # 2 Total joint replacement q 8 hours • Abdominal hysterectomy • Major Surgical Stress Pancreaticoduodenectomy Hydrocortisone • If procedure is uncomplicated, patient may Major trauma 100 mg IV • resume preoperative steroid dose on POD # 3 Sepsis q 8 hours • ARDS • Table 2.Corticosteroid Equivalencies Relative Relative Equivalent Route of Drug Mineralocorticoid Dose (mg) Administration Potency Potency (hrs) Betamethasone 0.6-0.75 IM,IV,PO 20-30 0 36-54 Dexamethasone 0.75 IM,IV,PO 25-30 0 36-54 Hydrocortisone 20 IM,IV,PO 1 2 8-12 Methylprednisolone 4 IM,IV,PO 5 0 18-36
Cotton BA, Guillamondegui OD, Fleming SB, Carpenter RO, Patel SH, morris JA et al. Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients. Arch Surg 2008; 143(1):62-67. Table 1. Recommendations for Steroid Replacement Therapy (12) Indications Total Daily Dosage Duration Minor Surgical Stress • Inguinal herniorrhaphy • Breast biopsy • Laparoscopic cholecystectomy Hydrocortisone 10 mg IV q 8 hours If procedure is uncomplicated, patient may resume preoperative steroid dose on POD # 1 Moderate Surgical Stress • Open cholecystectomy • Fem-pop bypass • Total joint replacement • Abdominal hysterectomy Hydrocortisone 25 mg IV q 8 hours If procedure is uncomplicated, patient may resume preoperative steroid dose on POD # 2 Major Surgical Stress • Pancreaticoduodenectomy • Major trauma • Sepsis • ARDS Hydrocortisone 100 mg IV q 8 hours If procedure is uncomplicated, patient may resume preoperative steroid dose on POD # 3 Table 2.Corticosteroid Equivalencies Drug Equivalent Dose (mg) Route of Administration Relative Potency Relative Mineralocorticoid Potency (hrs) Betamethasone 0.6-0.75 IM,IV,PO 20-30 0 36-54 Dexamethasone 0.75 IM,IV,PO 25-30 0 36-54 Hydrocortisone 20 IM,IV,PO 1 2 8-12 Methylprednisolone 4 IM,IV,PO 5 0 18-36
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