A 45-year-old woman has taken prednisone 15 mg daily for four months for autoimmune vasculitis. She undergoes major abdominal surgery under general anaesthesia. Which perioperative glucocorticoid plan is most appropriate?

• A No supplementation, continue her usual oral dose
• B ACTH stimulation testing before deciding on any supplementation
• C Dexamethasone 4 mg single dose at induction only
• D Hydrocortisone 50 to 100 mg intravenously per day covering the surgical period, then taper ✓

Explanation

More than three weeks of prednisone above approximately 5 mg daily suppresses the hypothalamic-pituitary-adrenal axis, risking intraoperative adrenal crisis. Major surgery warrants hydrocortisone around 100 mg per day (for example 50 mg at induction then infusion), tapered back to baseline over one to two days. Her chronic dose alone cannot mount a stress response, so option A is unsafe. Testing wastes critical time and is not required when recent supraphysiological steroid use is documented.

Reference: Morgan and Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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