Citation

Watson TD, Lee JF. Clin. Anesth. 1976; 11(2): 31-38.

Copyright

(Copyright © 1976, Davis)

DOI

unavailable

PMID

unavailable

Abstract

Anesthesiological problems in patients with severe trauma acutely intoxicated with alcohol are reviewed. A wide range of potentially hazardous drugs including barbiturates, hypoglycemics, amphetamines, antihistamines, steroids, and many others are being consumed with alcohol. Not only are drinking drivers taking a wider range of drugs, but they are also taking them in greater quantities. Even though the emergency patient may be intoxicated with a variety of illegal drugs, fear of prosecution will probably prevent him or her from giving an accurate history of drug intake. To date, only a few drugs can be readily detected by available laboratory investigation, and most of these can be identified only by means of tedious and expensive procedures which are not usually available. Less than 5% of emergency trauma patients were readily identified as chronic alcoholics on induction of anesthesia. Less information is available on the pharmacologic and physiologic effects of the common drugs than on alcohol, because misuse of the mind altering common drugs has only recently become a widespread problem. Do drug abusers who require surgery present drug related anesthetic problems? Amphetamines and LSD produce sympathomimetic effects which are dose related, including tachycardia, hypertension, arrhythmias, and fever, as well as paranoid and aggressive behavior. In view of these cardiovascular changes, pulse, blood pressure, and respiratory rates may be unreliable in assessing blood loss or anesthetic level. In addition, Johnston has reported that in dogs acute amphetamine administration increases MAC, but pretreatment with amphetamine decreases MAC. Hence, knowledge of recent amphetamine intake may be helpful in assessing the requirement for anesthetic drugs. There appears to be no drug interaction when marijuana and amphetamines are used simultaneously, but alcohol and marijuana each potentiate the effects of the other. Marijuana alone causes an increase in pulse rate which is potentiated by atropine and epinephrine. Narcotic, barbiturate, and amphetamine drug users frequently resort to intravenous route of administration. This practice ultimately results in destruction of superficial veins, rendering I.V. therapy and monitoring difficult and limited. Acute pulmonary edema following heroin overdosage has been known for some time. Whether this is due to the heroin or the adulterants used to dilute the street drugs is not known. Withdrawal symptoms, sometimes manifesting as hypotension during anesthesia, have to be borne in mind.

Keywords: Cannabis impaired driving; DUID; Ethanol impaired driving

Language: en

Keywords

Wounds and Injuries; human; survey; Ethanol; injury; Substance-Related Disorders; Stress; stress; therapy; alcohol; review; Alcoholism; alcoholism; Human; cannabis; amphetamine; article; addiction; intoxication; narcotic analgesic agent; drug abuse; alcohol intoxication; Alcoholic Intoxication; diamorphine; tranquilizer; drug intoxication; drug effect; lysergide; pathophysiology; tricyclic antidepressant agent; neuroleptic agent; meprobamate; anesthesia; Anesthesia; cardiovascular system; Cardiovascular System; phenobarbital; suxamethonium