• For use on the Heatherwood Hospital and Wexham Park Hospital sites

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition.

Print copies must be destroyed after use.

‘The need for patients on long term steroid cover treatment to increase their dose of glucocorticoids when under stress is a principle that rests in one of the most tranquil corners of medical dogma.’

Two case reports in the 1950’s subsequently lead to a virtually unchallenged protocol for operative cover lasting 50 years. It advised a four-fold increase in the dose of pre-op steroids for patients taking exogenous steroids. Despite the weight of evidence to the contrary, fears of precipitating Addisonian crisis have ensured that these supraphysiological regimes have continued unchallenged.

In 1998, Nicholson et al (Anaesthesia 1998, 53; 1091-1104) reviewed all the available evidence and published new guidelines which have been adopted by anaesthetists in the UK.