The patient on steroids is prone to a reduced stress response in response to surgery and anaesthesia. If minor surgery is contemplated, there is not a problem; the existing steroid dose is supplemented by a small amount, e.g. 100mg of hydrocortisone IM. Major surgery prophylaxis entails at least a doubling of this dose with increased doses post-operatively in response to requirements.
One should be wary of an Addisonian crisis on the day after surgery. Early symptoms and signs such as muscle weakness, polyuria, hypovolaemia and postural hypotension may be impossible to distinguish from a normal postoperative picture.
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