Hydrocortisone Dosing Guidelines

Perioperative Management

For adults undergoing major surgery, the American Society of Anesthesiologists recommends hydrocortisone dosing of 100 mg IV at induction, followed by a continuous infusion of 200 mg/24h, and post-operative dosing of 200 mg/24h IV while NPO or 50 mg every 6h IM, with a switch to double the usual oral dose for 48h or up to 1 week after surgery 1
For intermediate surgery, 100 mg IV hydrocortisone at induction, then double the regular dose for 48h is recommended 1
For bowel procedures, continuing the normal dose and using IV equivalent if prolonged NPO is advised 1
For major surgery in pediatric patients, hydrocortisone 2 mg/kg at induction, followed by a continuous IV infusion based on weight, is recommended: up to 10 kg, 25 mg/24h; 11-20 kg, 50 mg/24h; over 20 kg (prepubertal), 100 mg/24h; and over 20 kg (pubertal), 150 mg/24h, with post-operative dosing of double the usual oral doses for 48h 1
For minor procedures with general anesthesia, hydrocortisone 2 mg/kg IV/IM at induction and double normal doses for 24h when oral intake resumes is recommended 1
During labor and delivery, 100 mg IV hydrocortisone at onset, followed by a continuous infusion of 200 mg/24h or 100 mg IM, followed by 50 mg every 6h IM, is advised 1

For vasopressor-dependent septic shock, a dosage of 200 mg/day in four divided doses or continuous infusion of 240 mg/day (10 mg/hr) for ≥7 days may be considered 2
In children with fluid-refractory, catecholamine-resistant shock with suspected adrenal insufficiency, a dosage range of 1-2 mg/kg/day for stress coverage up to 50 mg/kg/day titrated to reverse shock may be indicated 3

The strength of evidence for these recommendations is not explicitly stated, but they are based on guidelines from reputable sources, including the American Society of Anesthesiologists 1
It is essential to individualize hydrocortisone dosing based on the specific condition being treated and patient response, with careful monitoring for both under-replacement and over-replacement 1