Patients on party drugs undergoing anesthesia

Drug abuse, especially with designer drugs, continues to grow, involving a wide demographic range. Consequently, anesthesiologists may be involved in the care of patients under the acute and chronic influence of a myriad of substances. In addition to the usual physiological damage to vital organs (heart, lungs, kidneys, and immune system) new evidence of permanent damage in regions of the brain responsible for memory and pain mediation is emerging. As drug use continues to increase, anesthesiologists must learn to detect drug abusing patients and avoid known interactions. This article will attempt to review the recent literature on this subject.

Cocaine, marijuana, ethanol, and heroin top the list of abused drugs, alone and in combination. The combined effects of these drugs can be synergistic in creating cardiovascular instability and toxicity. Because combinations create synergy in dopamine and serotonin transmission, addiction is possibly faster, more entrenched, and more difficult to treat. Anesthesiologists are now becoming involved in many of the rapid detoxification procedures to combat/treat addiction. Only limited research has addressed the newer designer drugs, but case reports regarding hyperthermia, cerebral edema, cerebral vasospasm, and lethal interactions with commonly used medications such as beta-blockers implicate the need for awareness in anesthesia personnel.

Drug abuse continues to be a major problem facing our society. Anesthesiologists encounter emergency cases in which 'party drugs' have clearly been used, and may also be anesthetizing patients in whom abuse is present but unrecognized. Understanding how illicit drugs interact with anesthetic agents is of paramount importance.