Perioperative Management In Patients With Long-Term Steroid Use

Agustia Sukri Ekadamayanti; Hendra  Zufry; Krishna Wardhana  Sucipto

doi:10.32734/jetromi.v2i1.2061

Authors

Agustia Sukri Ekadamayanti Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Universitas Syiah Kuala School of Medicine- dr.Zainoel Abidin General Teaching Hospital, Banda Aceh, Indonesia
Hendra Zufry Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Universitas Syiah Kuala School of Medicine- dr.Zainoel Abidin General Teaching Hospital, Banda Aceh, Indonesia https://orcid.org/0000-0002-0569-4617
Krishna Wardhana Sucipto Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Universitas Syiah Kuala School of Medicine- dr.Zainoel Abidin General Teaching Hospital, Banda Aceh, Indonesia

DOI:

https://doi.org/10.32734/jetromi.v2i1.2061

Keywords:

CORTICOSTEROID, HPA AXIS, SURGERY

Abstract

Abstract. Systemic corticosteroid given with oral or parenteral route is widely use in the treatment of various condition and has potent anti-inflammatory, immunomodulatory, and anti-neoplastic effect. Although steroid has potentially clinical benefit effects, long-term use of this regiment also associated with several serious risks and may deteriorate life quality and highly cost management. Long-term steroid use may altered our body response to stress due to HPA Axis suppression. Surgical procedure will increase stress in our body, which can led into higher demand of cortisol. When surgery performed, a signal from the operation site through afferent nervus will activate hypothalamus to release corticotropin releasing hormone, that will stimulate cortisol hyper secretion. Preoperative management guidelines recommend the use of stress dose or supplementation dose for patient with long-term steroid use, which will be discussed further in this review.

Keyword. CORTICOSTEROID, HPA AXIS, SURGERY

Abstrak. Kortikosteroid sistemik yang diberikan dengan rute oral atau parenteral banyak digunakan dalam pengobatan berbagai kondisi dan memiliki efek antiinflamasi, imunomodulator, dan anti neoplastik yang kuat. Meskipun steroid berpotensi memiliki efek manfaat klinis, penggunaan jangka panjang resimen ini juga dikaitkan dengan beberapa risiko serius dan dapat menurunkan kualitas hidup dan manajemen biaya tinggi. Penggunaan steroid jangka panjang dapat mengubah respons tubuh kita terhadap stres karena penekanan HPA Axis. Prosedur bedah akan meningkatkan stres di tubuh kita, yang dapat menyebabkan permintaan kortisol yang lebih tinggi. Ketika operasi dilakukan, sinyal dari tempat operasi melalui afferent nervus akan mengaktifkan hipotalamus untuk melepaskan hormon pelepas kortikotropin, yang akan merangsang sekresi hiper kortisol. Pedoman manajemen pra operasi merekomendasikan penggunaan dosis stres atau dosis suplemen untuk pasien dengan penggunaan steroid jangka panjang, yang akan dibahas lebih lanjut dalam ulasan ini.

Keyword. CORTICOSTEROID, HPA AXIS, SURGERY