09 April 2024 : Review article
A Review of the Current Status of Anesthetic Management of Patients with Rheumatoid Arthritis
Paweł Radkowski
123ABCDEFG, Maciej Szewczyk 4ABCDEFG*, Klaudia Sztaba 1F, Mariusz Kęska 12F
DOI: 10.12659/MSM.943829
Med Sci Monit 2024; 30:e943829
Table 3 Doses used in perioperative steroid management depending on the extent of the surgery.
| Type of surgery | Recommended doses according to procedures | Recommended doses for intra- and postoperative steroid cover in adults receiving adrenosuppressive doses of steroids | ||
|---|---|---|---|---|
| Intraoperative steroid replacement | Postoperative steroid replacement | Intraoperative steroid replacement | Postoperative steroid replacement | |
| Minor | Usual daily dose and hydrocortisone 50 mg intravenously before incision | Hydrocortisone 25 mg intravenously every 8 h for 24 h, then usual daily dose | Usual daily dose and hydrocortisone 100 mg intravenously at induction, followed by 200mg continuous infusion/24 h or dexamethasone 6–8 mg intravenously (if used will suffice for 24 h) | Double regular glucocorticoid dose for 48 h. After this time continue the usual treatment dose if recovery is uncomplicated |
| Moderate | Usual daily dose and hydrocortisone 50mg intravenously before incision | Hydrocortisone 25 mg intravenously every 8h for 24 h then usual daily dose | ||
| Major | Usual daily dose and hydrocortisone 100 mg intravenously at induction, followed by 200 mg continuous infusion/24 h | Hydrocortisone 50 mg intravenously every 8 h for 24 h. Taper dose by half per day until usual daily dose reached | 200 mg hydrocortisone intravenously/24h until patient can take drugs orally. If he can resume enteral double pre-surgical hydrocortisone doses for 48 h in uncomplicated recovery, otherwise double oral dose up to a week | |