Hydrocortisone Treatment Guidelines

Perioperative Management

The American Association of Anaesthetists recommends administering hydrocortisone 100 mg IV/IM at induction of anesthesia for major surgery, followed by 100 mg every 6 hours for 24-48 hours postoperatively, then transitioning to double the usual oral dose for 48 hours 1, 2
For minor procedures, a single dose of 100 mg IV/IM just before anesthesia is sufficient, with postoperative management involving doubling the oral dose for 24 hours only, then returning to normal maintenance 2, 3

In cases of acute adrenal crisis, immediately administer hydrocortisone 100 mg IV bolus, followed by continuous IV infusion of 200 mg/24 hours until the patient is stable 4, 5

The Association of Anaesthetists guidelines emphasize that patients on chronic steroids require the same stress-dose coverage protocol, with dexamethasone 6-8 mg IV potentially substituting for hydrocortisone in major surgery, but lacking mineralocorticoid activity 1, 4, 6
For primary adrenal insufficiency, add fludrocortisone once enteral feeding is established, and do not delay treatment for diagnostic procedures in suspected adrenal crisis, drawing blood for cortisol and ACTH before immediately starting treatment 2, 3, 4, 5

Children receive hydrocortisone 2 mg/kg IV/IM at induction, followed by weight-based continuous infusion, with postoperative management involving doubling the usual oral doses for 48 hours, then reducing to normal doses over up to one week 1, 4

When transitioning from IV hydrocortisone to oral hydrocortisone in adults with adrenal insufficiency, use a 1:1 dose equivalence and double the patient's usual maintenance dose for 48 hours post-stress, then return to standard maintenance dosing of 15-25 mg/day in divided doses, as recommended by the Anaesthesia guideline society 7
For patients recovering from major stress or surgery, discontinue IV hydrocortisone and immediately start oral hydrocortisone at double the usual maintenance dose for 48 hours, then reduce to the patient's standard maintenance regimen, according to the Anaesthesia guideline society 7

Ensure the patient can tolerate oral intake before discontinuing IV therapy, and if prolonged nil-by-mouth status is anticipated, continue IV dosing, as advised by the Anaesthesia guideline society 7

For children transitioning from IV to oral, administer double the usual oral doses for 48 hours, then reduce to normal doses over up to one week, as recommended by the Anaesthesia guideline society 7