The most appropriate management on the morning of surgery is for the patient to take her current morning prednisone dose of 5 mg. For patients on chronic glucocorticoids, appropriate medical management is crucial to prevent complications such as organ transplant rejection and adrenal insufficiency. Evidence to guide decision making is sparse; a recent Cochrane review found the available data insufficient to provide recommendations. Despite this, expert advice provides a fair consensus to inform clinical decision making. For patients taking low doses of prednisone (<10 mg/d), stress dosing of glucocorticoids typically is not required, even before high-risk surgical procedures (such as intrathoracic surgery). Instead, patients should take their usual glucocorticoid dose on the morning of surgery. This patient is scheduled for a low-risk procedure (carpal tunnel release) and is on a low dose of prednisone; therefore, taking the usual dose of prednisone on the morning of surgery is the most appropriate management.

Doubling the patient's usual prednisone dose is not the most appropriate choice because she is undergoing a low-risk procedure with minimal risk of perioperative adrenal insufficiency. Increasing her prednisone would only increase her risk of other complications, such as hyperglycemia.

Intravenous hydrocortisone is not necessary for this patient due to her low daily dose of prednisone and the low-risk nature of the procedure. Empiric intravenous hydrocortisone is reasonable for patients with primary adrenal insufficiency or for those on high doses of glucocorticoids (equivalent of prednisone ≥10 mg/d) who are undergoing higher risk surgeries. In those circumstances, intravenous hydrocortisone, 50 to 100 mg, is administered shortly before anesthesia induction and then continued every 8 hours for up to 48 hours after surgery.

Although the patient is on a low dose, withholding prednisone for the procedure is not recommended because interrupting therapy might cause unnecessary fluctuations in her immunosuppression or glucocorticoid levels without a clear benefit to her surgical outcome.