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Steroid Pada Anestesi
Steroid Pada Anestesi
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Special Article
Key words
Steroids; Replacement therapy; Hyper-reactive airway; Anaphylaxis; Post- operative nausea
& vomiting; Day care surgery; Septic shock; Cerebral oedema; Spinal cord oedema; Anti- inflammatory.
The steroids are among the most widely used class
of drugs and their role in the therapy of pulmonary, inflammatory, dermatological and oncological diseases has
been well described. There is an increasing application
of steroid therapy during perioperative period for various purposes. Some of the current indications are:1.
2.
3.
4.
5.
6.
Anaphylaxis
7.
Septic shock
8.
Compound
AntiNa
inflammat- retaining
ory potency potency
Duration
of
action
Equivalent
dose
Cortisol
20
Cortisone
0.8
0.8
25
Dexamethasone 25
0.75
Prednisone
0.8
Prednisolone
0.8
6-methyl
Prednisolone
0.5
Triamcinolone
Betamethasone
25
0.75
1. Professor, MD,MNAMS, 2. Senior Resident,MD, 3. Senior Resident, MD,DNB Department of Anaesthesia & Intensive Care Post
Graduate Institute of MedicalEducation and Research Chandigarh, Correspondence to :Prof. V K Grover, H. No. 53 Sector 24A, Chandigarh160023. E-mail-vinodkgrover@gmail.com
Accepted for publication on:1.8.07
389
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sial. The time required for the recovery from the suppression due to steroid intake varies from 2-5 days 3 to
nine months4. Certainly more suppression may be expected in the setting of higher and longer duration of
steroid therapy. Evaluation of the status of HPA axis
and the adrenal reserve of the patients who have received steroid therapy should be based on biochemical
testing, if available. A conservative estimate is to consider perioperative steroid therapy in all patients who
have received steroids for at least one month in the past
6-12 months.
High dose
immunosuppr
essive
Give usual
immunosuppressive dose
during
perioperative
period
Treat as if
on steroids
No perioperative steroids
necessary
Steroids as anti-inflammatory
Steroids profoundly alter both the cellular and humoral immune responses. These can prevent or suppress inflammation in response to multiple inciting events
including radiation, mechanical, chemical, infectious and
immunological stimuli. Multiple mechanisms are involved
in the suppression of inflammation by steroids. They
inhibit the production of various inflammatory factors
which are critical in generating and propagating the inflammatory response like interleukins, cytokines, and
chemotactic agents. As a result there is a decreased
release of vasoactive and chemo-attractive factors, di390
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Some studies have suggested steroid therapy in sepsis is not only associated with no clinicalimprovement, but
may be harmful18. However, River et al found that steroids may not be beneficial in all septic patients but for an
identifiable subgroup of patients they can be useful.
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Other purposes
1. Cerebral oedema: Steroids are of value in
reduction or prevention of cerebral oedema associated
with parasitic infections and neoplasms. The mechanism
by which steroids influence vasogenic oedema are
thought to include one or more of the following 3: (1) stabilization of cerebral endothelium, leading to a decrease
in plasma filtration; (2) increase in lysosomal activity of
cerebral capillaries; (3) inhibition of release of potentially toxic substances such as free radicals, fatty acids,
and prostaglandins; (4) electrolyte shifts favoring
transcapillary efflux of fluid; and (5) increase in local
and global cerebral glucose use, leading to improved
neuronal function.
References
1.
2.
Udebman R, Ramp J, Gallucci WT, et al. Adapting during surgical stress: a reevaluation of the role of glucocorticoids. J Clin
Invest 1986; 77:1377.
3.
4.
Livanou T, FerrimanD, James VHT. Recovery of hypothalamopituitary adrenal function after corticosteroid treatment. Lancet 1967; 2: 856-9.
5.
6.
7.
8.
Liu YH, Li MJ,Wang PC,et al. Use of dexamethasone for preventing po st o perative nausea and vomiting after
tymanomastoid surgery. Laryngoscope 2001; 111:1271-1274.
9.
10. Hirayama T, Ishii F, Yago K, Ogata H. Evaluation of the effective drugs for the prevention of nausea vomiting induced by
morphine used for post operative pain: a quantitative systematic review. Yakugaku Zasshi 2001; 121:179-185.
11. Tzeng JI, TsweiTS, Tang CS, et al. Dexamethasone alone does
not prevent post operative nausea vomiting in women undergoing dilatation and curettage: a comparison with droperidol
and saline. Acta Anaesthesiol Scand 2000; 38:137-142.
12.
392
Ali Movafegh, Ahmad RS, Ali Navi,et al.The effect of intravenous administration of dexamethasone on postoperative pain
,nausea,and vo miting after intrathecal injection of
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Ana Lucia S. Pappas, Radha Sukhani, et al. The effect of preoperative dexamethasone on the immediate and delayed postoperative
morbidity
in
children
und ergo ing
adenoidtonsillectomy. Anesth Analg 1998:87; 57-61.
18. Schroeder S, Wichers M, Kingmuller D, et al. The hypothalamic-pituitary adrenal axis of patients with severe sepsis:
altered response to corticotrophin releasing hormone. Crit Care
Med 2001;29 :310-316.
15. Coloma M, Duffy LL, White PF,et al .Dexamethasone facilitates discharge after outpatient anorectal surgery. Anesth Analg
2001; 92:85-88.
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