Perioperative Considerations for Patients Exposed to Psychostimulants.

Psychostimulants like amphetamines, cocaine, and entactogens pose challenges for anesthesia providers because each subclass has unique receptor activity and effects. These substances alter how anesthetic agents, adjuvants, and pain medications work, complicating perioperative care. The article reviews the epidemiology, pharmacology, and clinical implications of acute or chronic psychostimulant exposure, providing a foundation for safe management during surgery.

Study at a glance

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.