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Minor Surgery Steroid Supplementation — FRCA Final MCQ

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EasyPreoperative AssessmentMinor Surgery Steroid SupplementationFRCA Final

A 50-year-old man (ASA II) on long-term prednisolone 5 mg daily for polymyalgia rheumatica requires a minor day-case procedure (inguinal hernia repair). What steroid supplementation is required?

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Correct answer: E — Stop prednisolone completely for the day of surgery

For MINOR surgery (day case, local/peripheral nerve block procedures) in patients on physiological or low-dose steroids (prednisolone ≤10 mg/day), the Association of Anaesthetists (2020) recommends: continue the usual oral steroid dose on the morning of surgery with a sip of water. No additional IV hydrocortisone supplementation is required for minor procedures. For MODERATE surgery: usual dose + hydrocortisone 25 mg at induction. For MAJOR surgery: usual dose + hydrocortisone 25 mg at induction + 100 mg/24h for 48-72h. The key determinant is the magnitude of surgical stress, not the steroid dose.

Reference: Association of Anaesthetists – 2020 – Perioperative glucocorticoid management; RCOA – 2023 – Steroid supplementation