| Manejo anestésico de los pacientes que usan substancias ilegales |
Anesthetic management of the illicit-substance-using patient
Marcelle Hernandeza, David J. Birnbachb and Andre´ A.J. Van Zundert
Current Opinion in Anaesthesiology 2005, 18:315-324
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.
Keywords: anesthesia, illicit substance abuse
http://biblio.ugent.be/input/download?func=downloadFile&fileOId=562356
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| Anestesia y el usuario de Ecstasy |
MORO, Eduardo Toshiyuki; FERRAZ, Alexandre A. Fontana and MODOLO, Norma Sueli Pinheiro
Rev. Bras. Anestesiol 2006, vol.56, n.2, pp. 183-188. ISSN 0034-7094. doi: 10.1590/S0034-70942006000200010.
Abstracto
JUSTIFICATIVA Y OBJETIVOS: En los últimos años el número de nuevos usuarios de drogas ilícitas ha aumentado de forma significativa en todo el mundo. La marihuana y la cocaína, además del alcohol y del tabaco, han sido las drogas citadas frecuentemente, sin embargo, hubo un aumento significativo de usuarios de otros agentes psicoestimulantes o alucinógenos, como el Ecstasy, el GHB, el LSD y la metanfetamina, empleados con el objetivo de intensificar las experiencias sociales. El objetivo del presente artículo fue el de traer a colación la presentación clínica, los efectos destructivos y las potenciales interacciones con el acto anestésico en el paciente quirúrgico usuario de esas drogas ilícitas. CONTENIDO: El artículo discute los mecanismos de acción, la presentación clínica, los efectos destructivos y las posibles repercusiones observadas durante la anestesia en el usuario de MDMA (3,4-metilenodioximetamfetamina), conocido también como Ecstasy . CONCLUSIONES: La presentación clínica y los efectos destructivos provocados por el 3,4-metilenodioximetamfetamina (Ecstasy), como también potenciales interacciones con el acto anestésico, deben ser del conocimiento del anestesiólogo, pues en muchas situaciones esos usuarios serán sometidos a cirugías de emergencia, o incluso electivas. |
| Toxicidad aguda del Ectasy (MDMA) y compuestos relacionados: Visión general de la patofisiología y manejo clínico |
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+html
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| Anormalidades cerebrales estructurales, metabólicas y funcionales como resultados de la exposición prenatal a drogas de abuso: evidencias por neuroimagen |
Structural, metabolic, and functional brain abnormalities as a result of prenatal exposure to drugs of abuse: evidence from neuroimaging.
Roussotte F, Soderberg L, Sowell E.
Developmental Cognitive Neuroimaging Group, Department of Neurology, University of California, Los Angeles, CA 90095-7332, USA.
Neuropsychol Rev. 2010 Dec;20(4):376-97. Epub 2010 Oct 28.
Abstract
Prenatal exposure to alcohol and stimulants negatively affects the developing trajectory of the central nervous system in many ways. Recent advances in neuroimaging methods have allowed researchers to study the structural, metabolic, and functional abnormalities resulting from prenatal exposure to drugs of abuse in living human subjects. Here we review the neuroimaging literature of prenatal exposure to alcohol, cocaine, and methamphetamine. Neuroimaging studies of prenatal alcohol exposure have reported differences in the structure and metabolism of many brain systems, including in frontal, parietal, and temporal regions, in the cerebellum and basal ganglia, as well as in the white matter tracts that connect these brain regions. Functional imaging studies have identified significant differences in brain activation related to various cognitive domains as a result of prenatal alcohol exposure. The published literature of prenatal exposure to cocaine and methamphetamine is much smaller, but evidence is beginning to emerge suggesting that exposure to stimulant drugs in utero may be particularly toxic to dopamine-rich basal ganglia regions. Although the interpretation of such findings is somewhat limited by the problem of polysubstance abuse and by the difficulty of obtaining precise exposure histories in retrospective studies, such investigations provide important insights into the effects of drugs of abuse on the structure, function, and metabolism of the developing human brain. These insights may ultimately help clinicians develop better diagnostic tools and devise appropriate therapeutic interventions to improve the condition of children with prenatal exposure to drugs of abuse.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988996/pdf/11065_2010_Article_9150.pdf
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