Perioperative Considerations for Patients Exposed to Psychostimulants.
Anesthesia and analgesia – September 01, 2023
Source: PubMed
Summary
Acute psychostimulant intoxication poses significant challenges for anesthesia providers, particularly due to the diverse and evolving nature of these substances. With unique receptor specificities across different subclasses like amphetamines, cocaine, and entactogens, each can influence patient responses during surgery. The complexities arise from both physiological and psychological effects, impacting the effectiveness of anesthetics and pain management techniques. Understanding these factors is crucial for ensuring safe perioperative care for patients with acute or chronic psychostimulant exposure, ultimately enhancing patient outcomes.
Abstract
Concerns regarding the perioperative management of acute psychostimulant intoxication have been recognized for decades, but novel and diverse substances in this class continue to be developed. Despite the similarities in mechanisms of action among psychostimulants, each subclass within this broad category has unique receptor specificity and different mechanisms that play a role in patient clinical presentation. These issues present challenges to anesthesia providers when caring for patients with either acute or chronic exposure to psychostimulants during the perioperative period. Challenges result from both physiological and psychological effects that influence the action of the primary anesthetic agent, adjuvant anesthetics, and analgesics used for perioperative management of pain. The epidemiology, pharmacology, and perioperative implications of psychostimulant use are presented for amphetamines and similar acting nonamphetamines, cocaine, and, finally, the mixed-action drugs known as entactogens that share stimulant and psychedelic properties. This information is then used as the foundation for safe and effective perioperative management of patients exposed to psychostimulants.