The other thread got me thinking about a topic that I hadn't thought about in a while....I want to see/hear what other's opinions are. One of the many goals of anesthesia is to "blunt" the so-called "stress response" that surgery causes, because the "stress response" ultimately causes many of our perioperative complications: dvt, pe, mi, stroke, chf decompensation, dm decompensation, etc. The origins of these complications can be partially traced back to the rise of the stress hormones (adh, renin, alds, fib, cortisol, epi, norepi, etc.)which has a time course that is well documented in certain types of surgery...and which peaks often times HOURS after the surgery is over. Certain surgeries have little or no change in these hormones while others have dramatic changes...and the differences correlate with the likelihood of complications. As anesthesiologists, we strive to provide an anesthetic where we most effectively blunt this sequential/serial rise in the stress hormones. Regional anesthetics have been taunted as being the best at blocking this response...high dose narcotics does it fairly well also. So, I find in interesting that while on one hand we try our very best the "blunt" this stress response or provide a "stress free" anesthetic, that on the other hand, patients with "naturally" blunted responses (no adrenal glands or HPA suppression due to steroid use) we want to AUGMENT it? Thoughts?