Éxtasis/Ecstasy

Efectos tóxicos agudos del éxtasis y compuestos relacionados: revisión de su patofisiología y tratamiento.  Acute toxic effects of 'Ecstasy' (MDMA) and related compounds: overview of pathophysiology and clinical management. Hall AP, Henry JA. Department of Anaesthesia and Intensive Care Medicine, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW, UK. andrew.p.hall@uhl-tr.nhs.uk Br J Anaesth. 2006 Jun;96(6):678-85. Epub 2006 Apr 4. Abstract Since the late 1980s 'Ecstasy' (3,4-methylenedioxymethamphetamine, MDMA) has become established as a popular recreational drug in western Europe. The UK National Criminal Intelligence Service estimates that 0.5-2 million tablets are consumed weekly in Britain. It has been reported that 4.5% of young adults (15-34 yr) in the UK have used MDMA in the previous 12 months. Clinically important toxic effects have been reported, including fatalities. While the phenomenon of hyperpyrexia and multi-organ failure is now relatively well known, other serious effects have become apparent more recently. Patients with acute MDMA toxicity may present to doctors working in Anaesthesia, Intensive Care and Emergency Medicine. A broad knowledge of these pathologies and their treatment is necessary for anyone working in an acute medical speciality. An overview of MDMA pharmacology and acute toxicity will be given followed by a plan for clinical management. http://bja.oxfordjournals.org/content/96/6/678.full.pdf    Papel del dantroleno en el manejo de los efectos tóxicos agudos del éxtasis  Role of dantrolene in the management of the acute toxic effects of Ecstasy (MDMA) J. Moon, J. Cros Hemel Hempstead, UK The use of dantrolene in the management of hyperthermia for acute 'Ecstasy' (3,4-methylenedioxymetamphetamine, MDMA) toxicity has been recently reviewed by Hall and Hendry.1 We would like to confirm the efficacy of dantrolene after a recent case that presented to our emergency department. http://bja.oxfordjournals.org/content/99/1/146.1.full.pdf  Hipertermia inducida por MDMA: un sobreviviente de temperatura corporal inicial de 42.9ºC  MDMA induced hyperthermia: a survivor with an initial body temperature of 42.9 degrees C. Mallick A, Bodenham AR. Academic Unit of Anaesthesia, Leeds General Infirmary. J Accid Emerg Med. 1997 Sep;14(5):336-8. Abstract A young male survived hyperpyrexia (42.9 degrees C) following MDMA ("Ecstasy") ingestion. He developed convulsions, rhabdomyolysis, metabolic acidosis, and respiratory failure. This was successfully managed by assisted ventilation, aggressive fluid therapy, and the early administration of dantrolene, in addition to cooling measures. This is the first report of a survivor with such a severe hyperpyrexia. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1343106/pdf/jaccidem 00020-0064.pdf    Inducción de hipertermia maligna en cerdos susceptibles con 3-4-metilenedioxi metanfetamina (Éxtasis) Induction of malignant hyperthermia in susceptible swine by 3,4-methylenedioxy methamphetamine ("ecstasy"). Fiege M, Wappler F, Weisshorn R, Gerbershagen MU, Menge M, Schulte Am Esch J. Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. fiege@uke.uni-hamburg.de Anesthesiology. 2003 Nov;99(5):1132-6. Abstract BACKGROUND: 3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") can mediate acute toxic effects such as muscle rigidity, metabolic acidosis, and hyperthermia. Because of close clinical similarities, an association between MDMA intoxication and malignant hyperthermia (MH) was suggested. The aim of this study was to investigate whether MDMA is a trigger of MH in susceptible swine. METHODS: MH-nontriggering general anesthesia was performed in six MH-susceptible (MHS) and six MH-normal swine. The animals were exposed to MDMA in cumulative doses of 0.5, 1, 2, 4, 8, and 12 mg/kg. The clinical occurrence of MH was defined by achievement of two of three conditions: central venous Pco2 >/=75 mmHg, central venous pH </= 7.20, and increase of body core temperature >/= 2.0 degrees C. Once MH occurred, a standardized therapy with dantrolene, sodium bicarbonate, and hyperventilation with 100% oxygen was initialized. RESULTS: Administration of 8 mg/kg MDMA triggered MH in all MHS swine. The MH-normal swine also developed clinical signs of hypermetabolism, but even after administration of 12 mg/kg MDMA, changes were moderate compared with the MHS swine. Dantrolene therapy of MDMA-induced MH crisis in the MHS swine partially counteracted the clinical signs of MH immediately. CONCLUSIONS: MDMA induces MH in genetically susceptible swine in relevant doses. Therefore, MHS patients should avoid use of MDMA or related drugs. Patients with a personal or family history of MDMA-induced hyperthermia should be tested for a diagnosis of MH susceptibility. Dantrolene is effective in therapy of MDMA-induced porcine MH. http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2003&issue=11000&article=00020&type=abstract  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org