A 45-year-old taking prednisolone 7.5 mg daily for eight months requires emergency laparotomy for perforated bowel. Adrenal reserve has not been

Question

A 45-year-old taking prednisolone 7.5 mg daily for eight months requires emergency laparotomy for perforated bowel. Adrenal reserve has not been tested. Which perioperative plan is safest?

Accepted Answer

Continue the usual glucocorticoid and give parenteral stress-dose hydrocortisone for major surgery, then step down as haemodynamic stress resolves

Answer

Omit prednisolone and use dexamethasone as the principal measure as postoperative antiemetic prophylaxis

Answer

Continue prednisolone 7.5 mg alone because doses below 10 mg cannot suppress the hypothalamic-pituitary-adrenal axis

Answer

Reserve a single hydrocortisone bolus for postoperative hypotension and continue the baseline dose initially

Answer

Obtain a morning cortisol before surgery and commence replacement when the result is below the laboratory range

Perioperative Steroid Cover — RACP Adult Medicine MCQ

A 45-year-old taking prednisolone 7.5 mg daily for eight months requires emergency laparotomy for perforated bowel. Adrenal reserve has not been tested. Which perioperative plan is safest?