need help with intraop steriod coverage

[sawingzzzz's]

Is there a formula for how to figure out how much methylprednesone to give iv preop and intra op to cover a person on po steriods? I have looked in m&m and stoelting and there is not a formula to figure it or a dose range listed. thanks!

[Phishininau]

Hydocortisone is what we were taught to use to for supplementation preferentially over methyprednisone. Methylprednisone dosage should be 125mg IV, but up to 500mg with kidney transplants.

Hydrocortisone is 100mg IV. For DM patient, its 100mg the night before surgery, 25mg at induction, and 100mg over 24 starting after induction.

[Tia]

I concur with the Hydrocortisone but I was taught that 200-300 mg/70 KG is given for major surgeries and 25-100 mg for minor/elective surgeries. Has anyone else used this dosing? There are several ways to dose Hydrocortisone but the goal is to provide coverage while avoiding major side effects.

Some anesthesia providers won't dose for minor elective procedures unless they encounter refractive hypotension. It would be a good topic to discuss in an anesthesia conference or research to see if any evidence-based reports are available.

[catcolalex]

I just give 12 mg of decadron, just as easy.

[Focker, CRNA]

decadron lacks mineralocorticoid effects though, I think thats why hydrocortisone is preferred if you are using it for a pt. who has adrenocortical insufficiency.