Anesthesia for Drug Abusers

Clinton Piper, MS3

- Narcotics

- Barbs and Benzos

- Hallucinogens

- Amphetamines

- Cocaine

Anesthesia for Drug Abusers

Nick Nolte, 2002

Narcotics- Heroin, Morphine, Meperidine, Fentanyl, etc

Heroin OD? Find John Travolta and some adrenaline

- Anesthesia risks…

- hypotension (from adrenal suppression)

- perioperative respiratory depression --> avoid narcotic premedication

- Chronic user --> Continue normal drug dose during procedure recovery

- PTs often undertreated for pain...use aggressive dosing for analgesics

- Avoid opioid antagonists (naloxone)

Narcotics- Heroin, Morphine, Meperidine, Fentanyl, etc

- Inhaled anesthetics may need to be adjusted

- Acute intoxication → decreases MAC of inhaled agents

- Chronic use --> increases MAC - Minimal organ sys changes (vs narcotics)- Hepatic enzyme induction --> increased IV anesthetic requirements- Abrupt withdrawl --> delirium, seizures, hypotension

- Overdose- NG lavage and urine alkalinization

Barbs and Benzos

- Hallucinogens have long lasting effects 2 – 8 hrs.- Watch for autonomic disturbances (mediated by hypothalmamus)

- Tachycardia, HTN, increased secretions, N/V, rare seizures- Treat w alpha and beta blockade

- Stress of surgery/anesthesia --> psychotic reaction (flashbacks) - Rx: Thorazine, diazepam, barbs

Hallucinogens- LSD, Mushrooms (Psilocybin), Mescaline, etc

Which acceptable is slang for Amphetamines??

A. Black Molies, RoadDope, Turkey

B. L.A. Turnarounds, SparklePlenty, Bombido

C. Benny and the Jets, Cartwheels, Jam Cecil

D. Truckdrivers, Snow Seals, MinnieBennie

Pop quiz hotshot...

Which acceptable is slang for Amphetamines??

A. Black Molies, RoadDope, Turkey

B. L.A. Turnarounds, SparklePlenty, Bombido

C. Benny and the Jets, Cartwheels, Jam Cecil

D. Truckdrivers, Snow Seals, MinnieBennie

ANSWER: ALL OF THE ABOVE

Pop quiz hotshot...

- Stimulate alpha and beta receptors, increase catecholamine release/inhibits reuptake

- Acute intoxication → increases MAC

- Chronic abuse- decreases MAC (opposite of Barbs/Benzos)- blunts response to indirect-acting vasopressors- hypotension may require epinephrine

- Extremely high doses → toxic delirium, coma, cerebral hemorrhage, circulatory collapse

- Rx: Thorazine or Haldol; alpha and beta block, NG lavage, urine acidification

Amphetamines

- Stimulates dopaminergic neurons, inhibits NorEpi reuptake

- Autonomic effects...HTN, Tachy, Arrythmias, Hyperpyrexia- Inc risk of cardiac events and seizures during surgery

- Acute intoxication → increases MAC - Volatile anesthetics are acceptable

- Avoid Ketamine, gallamine, and pancuronium- aggressive sedation with barbs/benzos/haldol

Cocaine

- Narcotics

- Don't undertreat pain

- Watch for hypotension/respiratory depression

- Barbs and Benzos

- Adjust MAC (Acute --> dec; Chronic --> inc)

- Inc IV anesthetics (hepatic enzyme induction)

- Hallucinogens

- watch out for inc. secretions and flashbacks

- helps to play Grateful Dead in OR

- Amphetamines

- Adjust MAC (Acute --> inc; Chronic --> dec)

- Cocaine

- Adjust MAC (Acute --> inc)

- Avoid Ketamine

Keys to 'Winning'