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"Robo-tripping": dextromethorphan abuse and its anesthetic implications
Kelly A Linn1, Micah T Long1, Paul S Pagel1
1Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.
Anesthesiology and Pain Medicine
|March 21, 2015
Summary
This case study highlights a patient with high-dose dextromethorphan (DXM) abuse undergoing surgery. Anesthesiologists must understand DXM pharmacology due to its increasing recreational use and potential anesthetic risks.
Area of Science:
- Anesthesiology
- Clinical Pharmacology
- Pharmacology
Background:
- Dextromethorphan (DXM) is increasingly abused recreationally, particularly by adolescents and young adults.
- High-dose DXM consumption can lead to significant neuropsychiatric and sympathetic nervous system effects.
- Understanding DXM's clinical pharmacology is crucial for safe anesthetic management.
Observation:
- A 30-year-old male patient scheduled for elective septorhinoplasty reported consuming 1440-1800 mg of DXM daily for six years.
- The patient had a history of DXM dependency with urine levels exceeding 2000 ng/mL.
- He reported dissociative effects from DXM abuse but abstained for 48 hours prior to surgery.
Findings:
- DXM acts as an N-methyl-D-aspartate receptor antagonist.
- DXM has a relatively short half-life, and the patient experienced no significant withdrawal symptoms after 48 hours of abstinence.
- Despite abstinence, DXM's stimulant effects on the nervous system were recognized as a potential anesthetic concern.
Implications:
- Anesthesiologists must be aware of the potential risks associated with recreational DXM abuse.
- Knowledge of DXM's pharmacology is essential for managing patients with a history of substance abuse.
- This case underscores the importance of comprehensive patient history and risk assessment in anesthesia.