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Anesthetic management of the illicit-substance-using patient

Hernandez, Marcellea; Birnbach, David Jb; Van Zundert, André AJc

Current Opinion in Anaesthesiology: June 2005 - Volume 18 - Issue 3 - p 315–324
doi: 10.1097/
Anaesthesia and medical disease

Purpose of review During the last few years, drug abuse has risen to the point that almost 20 million Americans are current abusers of illicit substances. These patients present to us as anesthesiologists in a variety of circumstances: in obstetrics for labor and emergencies, in trauma for emergency surgeries or life-saving (resuscitative) situations and in everyday elective surgeries. Therefore it is important for anesthesiologists to know about the most common illicit drugs being used, to know their side effects and clinical presentation if abused or intoxicated, and to know what anesthetic options would be beneficial or detrimental.

Recent findings In this article we will review some of the most commonly used illicit drugs, their effects on the organ systems and some tips to take into consideration when providing anesthesia for these patients. We will discuss marijuana, cocaine, opioids, hallucinogens, solvents and the newer so-called rave or club drugs. Newer treatment options for opioid detoxification will also be discussed.

Summary Illicit substance abuse is a major health concern in the United States. Drug use, either acute or chronic, has potentially grave consequences which include changes affecting the pulmonary, cardiovascular, nervous, renal and hepatic systems. Anesthesiologists come into contact with these patients in emergency and everyday situations. Due to the diverse clinical presentations that may arise from single substance or polysubstance abuse, anesthetic management should be tailored to each individual and universal precautions should always be followed when providing care.

aJackson Memorial Hospital, University of Miami School of Medicine, Miami, FL, USA

bDepartment of Anesthesiology, Miller School of Medicine of the University of Miami, Chief, Women's Anesthesia, Jackson Memorial Hospital, Miami, FL, USA

cCatharina Hospital - Brabant Medical School, Department of Anesthesiology, ICU and Pain Clinic, Eindhoven, The Netherlands

Correspondence to Professor A.A.J. van Zundert, MD, PhD, FRCA, Catharina Hospital - Brabant Medical School, Department of Anesthesiology, ICU & Pain Clinic, Michelangelolaan 2, NL-5623 EJ, Eindhoven, The Netherlands Tel: +31 40 2399 111; e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.