Anaesthesia and substance abuse

Wood, Pamela; Soni, Nikhil Kumar

doi:10.1111/j.1365-2044.1989.tb13593.x

Cited by 25 publications

(6 citation statements)

References 48 publications

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“…Although the interaction between amphetamine and anesthesia is a known phenomenon (1, 4), there is limited information regarding its anesthetic physiologic and pharmacologic effects.…”

Section: Discussionmentioning

confidence: 99%

Altered response to intravenous thiopental and succinylcholine in acute amphetamine abuse

Stibolt¹,

Wachowiak-Andersen

2002

Acta Anaesthesiol Scand

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“…Although the interaction between amphetamine and anesthesia is a known phenomenon (1, 4), there is limited information regarding its anesthetic physiologic and pharmacologic effects.…”

Section: Discussionmentioning

confidence: 99%

Altered response to intravenous thiopental and succinylcholine in acute amphetamine abuse

Stibolt¹,

Wachowiak-Andersen

2002

Acta Anaesthesiol Scand

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“…However, disadvantages may include lack of patient compliance [30], infection risk from needle-stick injuries, and a need for reduction in the dose of local anaesthetic if there is either pre-existing hepatic dysfunction or significant hypoalbuminaemia [31]. NSAIDS, paracetamol and adjuvant drugs and techniques: Multimodal analgesia [32] with paracetamol, NSAIDs and adjuvant drugs remains the backbone of pain management in the same way as it is in patients without any drug dependence.…”

Section: General Treatment Guidelinesmentioning

confidence: 99%

“…Local anaesthetic techniques: If feasible, local anaesthetic techniques should be used as sole or adjunct pain relief, as it has been shown to be particularly advantageous in opioid dependent patients, potentially obviating the need for additional opioids [28,29]. However, disadvantages may include lack of patient compliance [30], infection risk from needle-stick injuries, and a need for reduction in the dose of local anaesthetic if there is either pre-existing hepatic dysfunction or significant hypoalbuminaemia [31]. NSAIDS, paracetamol and adjuvant drugs and techniques: Multimodal analgesia [32] with paracetamol, NSAIDs and adjuvant drugs remains the backbone of pain management in the same way as it is in patients without any drug dependence.…”

Section: General Treatment Guidelinesmentioning

confidence: 99%

Acute pain management for opioid dependent patients

Mehta¹,

Langford

2006

Anaesthesia

137

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SummaryPatients requiring acute pain management may be opioid dependent as a result of either recreational or therapeutic opioid use, including those in opioid addiction programmes. Pain in these patients is often under-estimated and under-treated. In addiction, drug-seeking behaviour differentiates it from simple dependence. With few randomised controlled trials, current evidence predominantly consists of guidelines based on case reports, retrospective studies and expert opinion. Consensus recommendations include maintaining regular provision of the patient's pre-existing opioid requirement, with additional analgesia, ideally multimodal, in appropriate combinations of short-acting opioid (as required), local anaesthesia, and adjuvant anti-inflammatory analgesics and paracetamol. Patient controlled analgesia with higher bolus doses and shorter lock-out intervals is a recommended strategy. Transdermal opioid patches and implantable pumps will continue to deliver opioid, to which non-opioid and short-acting opioids may be added. Re-exposure to opioid is ideally avoided in previously addicted patients, but if not feasible, opioid therapy should be prescribed.

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“…Epidural analgesia is preferable to systemic opioid analgesia, since adequate doses are difficult to predict and achieve. To avoid acute opioid withdrawal during labour, replacement of the patient's usual opioid dose with an equivalent dose of oral, parenteral or epidural opioid is suggested, in addition to providing new dose requirements 8,47,48 Although methadone is an effective analgesic, alternative mu-opioid receptor agonists for the treatment of acute pain are preferred to clearly distinguish between the treatment of addiction and the treatment of pain 7 . In addition, the slow onset of action and long half-life of methadone make it difficult to titrate it rapidly enough to control acute pain 7 .…”

Section: Opioidsmentioning

confidence: 99%

Drug Abuse and Dependency during Pregnancy: Anaesthetic Issues

Ludlow

Christmas

Paech

et al. 2007

Anaesth Intensive Care

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Drug abuse is a significant social problem that can lead to serious obstetric complications, some of which may be confused with pregnancy-related disease states. Substance abuse poses a number of challenges with respect to the management of pain and the conduct of anaesthesia in the peripartum period. This review was based on information from a literature search of epidemiological, research and review papers on substance abuse during pregnancy, obtained for the purpose of preparing a background paper for the Ministerial Council on Drug Strategy, Commonwealth Government of Australia. Given that almost 80% of substance-abusing parturients require anaesthetic services in the perinatal period, early antenatal referral for anaesthetic review is recommended. To optimise the care of these vulnerable patients, obstetricians, general practitioners and midwives should attempt to identify substance-abusing parturients and refer them to an anaesthetist. A careful anaesthetic evaluation with non-judgemental questioning is essential, with management tailored to individual patient needs and the urgency of obstetric intervention for vaginal delivery or caesarean section. Opioid-dependent women, in particular, benefit from antenatal pain management planning. Patients recovering from drug addiction should also have a well-documented analgesic strategy. A multidisciplinary approach will involve obstetricians, anaesthetists and staff of the Drug and Alcohol Service. In acute admissions of women by whom antenatal care was not accessed, a high index of suspicion for illicit drug use should arise. Because illicit substance use is so prevalent, if untoward reactions occur during an otherwise uneventful anaesthetic, the possibility of drug abuse should be considered.

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Anaesthesia and substance abuse

Abstract: SummaryCurrent practices in the abuse of illicit drugs in the United Kingdom are described with particular reference to their pathological effects and the implications for anaesthesia. Practical guidelines are given for the anaesthetic and peri-and postoperative management of addicts.

Cited by 25 publications

References 48 publications

Altered response to intravenous thiopental and succinylcholine in acute amphetamine abuse

Altered response to intravenous thiopental and succinylcholine in acute amphetamine abuse

Acute pain management for opioid dependent patients

Drug Abuse and Dependency during Pregnancy: Anaesthetic Issues

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