During bilateral adrenalectomy, intraoperative dose of hydrocortisone should be given after -
About corticosteroids given in adrenalectomy, the maximum we could get is mentioned below. The answer has been confirmed by a good knowledgeable Prof. in Surgery.
Schwartz 9/e p1397 writes-
"Patients undergoing surgery for a primary adrenal adenoma secreting glucocorticoids require preoperative and postoperative steroids due to suppression of the contralateral adrenal gland. Duration of steroid therapy is determined by the ACTH stimulation test. Exogenous steroids may be needed for up to 2 years but are needed indefinitely in patients who have undergone bilateral adrenalectomy. This latter group of patients also may require mineralocorticoid replacement therapy."
Sabiston 18/e p1013 writes-
"Perioperative and postoperative glucocorticoid administration is obviously essential in the care of patients with Cushing's syndrome. For patients undergoing adrenalectomy for Cushing's syndrome, perioperative "stress dose" steroids (hydrocortisone, 100 mg IV every 8 hours for 24 hours) are recommended."
Note that Bailey (25/e p811) & CSDT (13/e p749) differ from Schwartz and Sabiston. According to them only post operative steroids are given.
Opening the abdomen
Ligation of left adrenal vein
Ligation of right adrenal vein
Excision of both adrenal glands