"Robo-tripping": dextromethorphan abuse and its anesthetic implications.
Anesthesiology and pain medicine December 1, 2014 Kelly A Linn, Micah T Long, Paul S Pagel
A 30-year-old man who consumed 1440 to 1800 mg of dextromethorphan daily for six years—12 to 15 times the maximum recommended dose—was scheduled for elective septorhinoplasty. He had previously been treated for dextromethorphan dependency, with urine levels exceeding 2000 ng/mL, and reported marked dissociative effects from the drug. After abstaining for 48 hours before surgery without major withdrawal symptoms, the authors proceeded with the case, noting dextromethorphan's short half-life and its neuropsychiatric and sympathetic nervous system stimulant effects as an NMDA receptor antagonist. Anesthesiologists should be aware of its clinical pharmacology due to rising recreational abuse among adolescents and young adults.