Anaesthetic implications of psilocybin and lysergic acid diethylamide: what is old is now new
European Journal of Anaesthesiology – February 18, 2025
Source: OpenAlex
Summary
The growing therapeutic use of hallucinogens like Psilocybin and Lysergic acid diethylamide (LSD) in Medicine necessitates careful Anesthesia considerations. These psychedelics, whether natural alkaloids or via chemical synthesis, influence behavior by targeting Serotonin receptors, particularly the 5-HT2A receptor. Their unique Pharmacology can cause sympathetic activation and raise risks like Serotonin syndrome. Mescaline also presents autonomic challenges. Understanding these Neurotransmitter Receptor Influence on Behavior is crucial for safe patient management during Anesthesia, highlighting a vital area in Psychedelics and Drug Studies.
Abstract
Psychedelic drugs, known for their perception-altering properties, are gaining popularity in the treatment of mental health and pain disorders. As exploratory studies demonstrate clinical efficacy with few adverse events, it is expected that more patients will ingest psychedelic drugs. For therapeutic reasons, as with any drug, anaesthesiologists must be aware of its physiological effects and contraindications to ensure the safe provision of anaesthesia. Psilocybin is a 5HT 1A and 5HT 2A serotonin receptor agonist thought to act on excitatory and inhibitory neurons in the brain. Acute ingestion causes sympathetic nervous system activation, which can precipitate haemodynamic instability. Activation of the 5HT serotonin receptors can also place the patient at risk of serotonin syndrome. Chronic use increases plasma concentrations of cortisol, which has implications on prophylactic stress-dosing of glucocorticoids preoperatively. Lysergic acid diethylamide (LSD), a synthetic psychoactive substance, is also a 5HT2 A agonist. LSD has been shown to potentiate opioid analgesics, and monoamine oxidase (MAO) inhibition. Historical reports suggest that LSD has anticholinesterase activity and can prolong neuromuscular block with depolarising muscle relaxants. Mescaline is a poorly understood psychedelic with similar autonomic effects. Historical studies have shown decreased neuromuscular transmission and an association with malignant hyperthermia. When managing patients who have consumed psychedelics drugs, it is important to consider delaying surgery whenever possible, to allow acute intoxication to wane. A high degree of suspicion and an understanding of management principles is vital to the safe conduct of anaesthesia. Future research should explore therapeutic doses of psychedelic drugs to understand physiologic effects at various concentrations.