Supporting NHS Patient Drug Safety 

                The right dose of the right drug at the right time.

Do I need Perioperative Steroids?

As a clinician have you ever thought how to assess a patient who may be taking oral, topical or inhaled steroids on how these should be increased or kept at the same dose in the perioperative period and if the patient needs tests of the HPA ( Hypothalamic-Pituitary-Axis ) before a surgical procedure?

I was asked by one of my Consultant Geriatrician colleagues who is the the Liaison Physician for the elderly patients on the Orthopaedic Ward of my hospital to do a presentation on identifying patients who need Perioperative Steroids.

I analysed a recent paper on this subject entitled 'The Surgical Patient taking glucocorticoids' by Amir H.Hamrahian, Sanzian Roman and Stacey Milan, published in the on-line medical information resource UptoDate.

Below are links to a collection of clinical algorithms in the form of flow charts derived from this article.

UptoDate is a very useful resource for the management of medical condtions but many of the algorithms in its articles are poorly designed and contain errors. The topic of Perioperative Steroids is ideally suited to algorithms but the UptoDate article does not include any! 


1. The algorithm for deciding if a patient needs perioperative steroids.( Click on the circle to load the algorithm )

"Periop Steroid Algorithm"

2. The algorithm for identifying patients with uncertain adrenal function who may need a 9 am cortisol or a Short Synacthen ( ACTH ) Test.

"HPA Axis Assessment Algorithm"

3. The algorithm showing the various steroid regimens depending on the type of surgical procedure.

"Periop Steroid Algorithm"

 4. The algorithm showing the various steroid regimens for patients with Addison's Disease undergoing surgery.

"Periop Adrenal Failure Algorithm"


I am currently working on a mobile version of this web site using the open source Javascript Development Framework called Jquery Mobile ( JQM ).

This Responsive Web Design ( RWD ) will run on all Platforms ( Operating Systems ) and work on PCs, tablets and smartphones, on all browsers.

JQM supports Javascript Object Notation ( JSON ) and AJAX ( Asymmetric Javascript with XML ).

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