Anesthetic management of the illicit-substance-using patient
Hernandez M, Birnbach DJ, Van Zundert AA.
(a)Jackson Memorial Hospital, University of Miami School of Medicine, Miami, FL, USA (b)Department of Anesthesiology, Miller School of Medicine of the University of Miami, Chief, Women's Anesthesia, Jackson Memorial Hospital, Miami, FL, USA (c)Catharina Hospital - Brabant Medical School, Department of Anesthesiology, ICU and Pain Clinic, Eindhoven, The Netherlands.
Curr Opin Anaesthesiol. 2005 Jun;18(3):315-324.


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.
Adverse effects
General anaesthetics
Obstetric anaesthesia
Molecular mechanisms
Inhalational techniques
Nitrous oxide: adverse effects
Parkinson's disease and anaesthetics
Anaesthesia: rivalries and discoveries
Consciousness, anaesthesia and anaesthetics
Anaesthetic effects on neurotransmitter uptake

and further reading
Future Opioids
BLTC Research
Utopian Surgery?
The Good Drug Guide
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World