Steroids are perhaps one of the most widely used group of drugs in present day anaesthetic practice, sometimes with indication and sometimes without indications. Because of their diverse effects on various systems of the body, there has been renewed interest in the use of steroids in modern day anaesthetic practice. This paper focuses on the synthesis and functions of steroids and risks associated with their supplementation. This paper also highlights the recent trends, relevance, and consensus issues on the use of steroids as adjunct pharmacological agents in relation to anaesthetic practice and intensive care, along with emphasis on important clinical aspects of perioperative usefulness and supplementation. 1. Introduction Corticosteroids and their biologically active synthetic derivatives differ in their metabolic (glucocorticoid) and electrolyte-regulating (mineralocorticoid) activities. These agents are employed at physiological doses for replacement therapy when endogenous production is impaired. In addition, glucocorticoids potently suppress inflammation, and their use in a variety of inflammatory and autoimmune diseases makes them among the most frequently prescribed classes of drugs [1, 2]. The effects of corticosteroids are numerous and widespread and include alterations in carbohydrate, protein lipid metabolism; maintenance of fluid and electrolyte balance; and preservation of normal function of the cardiovascular system, the immune system, the kidney, skeletal muscle, the endocrine system, and the nervous system. In addition, corticosteroids endow the organism with the capacity to resist such stressful circumstances as noxious stimuli and environmental changes [1, 3, 4]. 2. Regulation of Cortisol Secretion The following three major mechanisms control ACTH release and the Cortisol secretion. (a) Negative feedback mechanism: the most important stimulus for secretion of cortisol is the release of ACTH from anterior pituitary. The secretion of ACTH in anterior pituitary is determined by two hypothalamic neurohormones (diurnal release of CRF and AVP) that act synergistically [3–5]. Circulating cortisol also exerts a direct negative feedback on the hypothalamus and anterior pituitary to decrease the release of CRF and ACTH from respective sites.(b) Diurnal variation: cortisol is secreted from adrenal gland in an episodic manner and frequency of pulses follows a circadian rhythm that is dependent on both day-night and sleep-wake patterns and is disrupted by alternating day-night shift working patterns and by long distance travel across time zones.
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