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Peri-operative Glucocorticoid Supplementation – A Scottish Perspective

Stewart Cartmill, John Muthiah
Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom


Introduction: We endeavoured to look at the impact on practice amongst anaesthetists in Scotland of the 2020 joint guideline on the management of glucocorticoids during the peri-operative period. A major change in this guideline was the recommendation of a continuous infusion of hydrocortisone at 200 mg.24 h−1, following a 100mg bolus, at induction of anaesthesia in adult patients with adrenal insufficiency from any cause.

Methods: We conducted an electronic survey, using SurveyMonkey, on the current practice in Scotland between 01/07/2021- 30/07/2021. We emailed the survey to the anaesthetic department secretary of every hospital in NHS Scotland.

Results: We received 28 completed surveys. 20 consultants and 8 trainees.
71.4% (n=20) stated they wound not consider commencing a hydrocortisone infusion in day surgery/ 23 hour stay patients, due to possible impact on early mobilisation/ discharge. Of these respondents, 80% (n=16), stated they would give a bolus dose of IV steroid at induction of anaesthesia but would not prescribe further IV steroids.
67.9% (n=19), stated they would not consider commencing a hydrocortisone infusion patients on enhanced recovery after surgery (ERAS) pathways. Of these respondents, 37% (n=7) stated they would prescribe a bolus regimen of hydrocortisone 50mg QID.

Conclusions: We are interested in the impact of commencing a hydrocortisone infusion on the suitability of patients with potential adrenal suppression for day case surgery and ERAS. Previous evidence has not support supplemental steroids for less invasive procedures.
Our survey suggests there is heterogeneity in peri- operative corticosteroid supplementation amongst anaesthetists in Scotland.