Table 3.
Surgical Stress according to Procedures and Recommended Dosing of Glucocorticoid [7]
| Type of surgery | Estimated cortisol secretion rate | Examples | Recommended dosing |
|---|---|---|---|
| Superficial | 8–10 mg/day | Dental surgery | Usual daily dose |
| Biopsy | |||
| Minor | 50 mg/day | Inguinal hernia repair | Usual daily dose plus |
| Colonoscopy | |||
| Uterine curettage | Hydrocortisone 50 mg IV before incision | ||
| Hand surgery | Hydrocortisone 25 mg IV every 8 h × 24 h | ||
| Moderate | 75–150 mg/day | Lower extremity revascularization | Then usual daily dose |
| Total joint replacement | |||
| Cholecystectomy | |||
| Colon resection | |||
| Abdominal hysterectomy | |||
| Major | 75–150 mg/day | Esophagectomy | Usual daily dose plus |
| Total proctocolectomy | Hydrocortisone 100 mg IV before incision | ||
| Major cardiac/vascular surgery | Followed by continuous IV hydrocortisone 200 mg (> 24 h) | ||
| Hepaticojejunostomy | or | ||
| Delivery | Hydrocortisone 50 mg IV every 8 h × 24 h | ||
| Trauma | Taper dose by half per day until usual daily dose reached |
IV: intravenously.