Dr S Parthasarathy MD DA DNB MD Acu Dip Diab DCA Dip Software statistics PhD physiology FICA IDRA CUGRA Definition Substance abuse may be defined as selfadministration of ID: 999015
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1. Substance abuse and anesthesia Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statistics- PhD ( physiology),FICA, IDRA , CUGRA
2. Definition Substance abuse may be defined as self-administration of drug(s) that deviate(s) from accepted medical or social use which if sustained can lead to physical and psychological dependence.Leave out alcohol and smoking – separate topics
3. Ministry statistics 2018
4. All substance abuse – 2.5 – 2.8 % Males – 4 % Females – 0.2 – 0.3 % India
5. According to a UN report, One million heroin addicts are registered in India, and unofficially there are as many as five million50 % of students have atleast tried once !!
6. Marijiuana Marijuana can be smoked as a cigarette (a joint), using a water pipe or using a hollow cigar filled with marijuana (a blunt); it can also be taken orally. Its users experience an intense feeling of relaxation within minutes and a pleasant euphoria that last several hours.May be for 30 days Think of abstinence
7. The list is quite big !! Gutka Fevicol Molasses Paints and thinners HaansNail polishCool lip – sublingual granules of ? Hansg-Hydroxybutyric AcidBath salts – cathinones
8. Route Oral Nasal Inhaled Injection Sublingual
9. Gutkha guṭkha is a chewing tobacco preparation made of crushed areca nut, tobacco, catechu, paraffin wax, slaked lime and sweet or savory flavourings, commonly used in some parts of India. It contains carcinogens, is considered responsible for oral cancer and other severe negative health effects and hence is subjected in India to the same restrictions and warnings as cigarettes
10. Cool lip by school students !!
11. Whitener The pungent smell of whitener can not only erase print on paper, but also memory from the human brain. The toluene and trychloroethane help to intoxicate and apparently the addicts experience a kick for five to eight hours,
12. Only toluene Symptoms of toluene poisoning include CNS effects (headache, dizziness, ataxia, drowsiness, euphoria, hallucinations, tremor, seizures, and coma), ventricular arrhythmias, ANS – gone !!chemical pneumonitis, respiratory depression, nausea, vomiting, and electrolyte imbalances
13. Sniffing glue Demyelination Lung damage – Type 1 respiratory failure Arrhythmias Liver damage Seizures
14. Nail polishDangerous acetone levelsStarve Ketoacidosis
15. Molasses to ethanol !! Thirumandangudi Sugar factory in kumbakonam Molasses packed to cyclone areas !!? Ethanol !!
16. Lip balmLip balm or lip salve is a wax-like substance applied topically to the lips to moisturize and relieve chapped or dry lips, angular cheilitis, stomatitis, or cold sores. Lip balm often contains beeswax or carnauba wax, camphor, alcohol, lanolin, paraffin, and petrolatum, among other ingredients. Some varieties contain dyes, flavor, fragrance, phenol, salicylic acid, and sunscreen
17. Incidence in schools in tamilnadu Even among girls present I would put as 5 - 10 %School droppers – still very high
18. Anesthetic concerns – marijuana Cannabinoids Sympathetic stimulation – tachycardia Goes later to myocardial depression Life threating arrhythmias on inductionAirway irritability Bronchospasm STT changes in ECG !!
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20. Cocaine abuse Cocaine is extracted from the leaves of Erythroxylon coca, a plant indigenous to South AmericaCocaine interferes with presynaptic uptake of sympathomimetic neurotransmitters (e.g. norepinephrine, serotonin and dopamine
21. Cocaine and anesthesia Platelet count Hypertension in induction Arrhythmias on induction Ephedrine resistant hypotension – may be Phenylephrine Changes in pain perception may complicate regional anesthesia – may complain of pain after blockade
22. Cocaine !! Beta -Blockers, such as propanolol, are contraindicated in these patients because of the potential for unopposed a-adrenergic stimulationUse labetolol ?? Halothane ? Ketamine ? Etomidate and seizures Propofol and thio – OK Scoline and cocaine compete ??
23. Cocaine Nitroprusside, nitroglycerin, or demedetomidine may be used to control blood pressure. Hemodynamic instability may occur during acute intoxication when the patient can be hypertensive and hyperthermic, or hypotensive as a result of catecholamine depletionThinking about malignant hyperthermia
24. Cocaine !! Patients under regional anesthesia may also show combative behavior and altered pain perception, perhapsdue to changes in m- and k-opioid receptor densities and abnormal endorphin levelsrecommend a cocaine-free interval of at least 1 week before elective surgical procedures
25. Place close to us !!
26. Methamphetamine and AmphetaminesMeth mouth ! – bad smell poor hygiene Cardiac diseases, pulmonary hypertension nasal septal necrosis Aortic dissection Postoperative managementMethamphetamine withdrawal peaks at 24 hours after last use and is characterized byincreased sleeping, eating, and depression symptoms
27. Opioid abuse IV access HIV HbsAg Anesthesia - analgesia – high doses needed Hypoxemia Gastric emptying and aspiration
28. Opioids Reduced intravascular fluid volume, malnutrition or liver disease may require appropriate dose adjustments of anaesthetic drugs.RA is OK but HIV ?? Clonidine for withdrawal symptoms
29. Opioids Opioids need to be continued to prevent withdrawal, but other medications, such as acetaminophen,NSAIDs,, gabapentin, and pregabalin, may be included in a multimodal therapy regimen. Ketamine - decrease hyperalgesia= NMDA antagonist
30. LSD Lysergic Acid Diethylamide - legal drug till 1960sToxic effects include hallucinations, dilated pupils, synesthesia, tachycardia, tachypnea, fever, hypertonia, and hyperglycemia. Effects last from 6 to 10 hours
31. Pan supari ! Smoke Leave alone chemicals !! It is worthwhile to categorize all these patientsas having "anticipated difficult airwaysPreoperative laryngoscopic evaluation !! SMF Opening the mouth !!
32. Room deodorizersVolatile nitrites, such as amyl nitrite, butyl nitrite, and related compounds. Euphoria but profound hypotension and cutaneous flushing followed by vasoconstriction and tachycardia; methemoglobinemia and increased bronchial irritation
33. Acute or chronic Operations on acutely intoxicated patients should be delayed, if possible, because of the potential for hemodynamic instability. 3- 4days ?? Those caring for a substance user postoperatively should be wary of the potential for hemodynamic compromise, poor wound healing, altered consciousness, and difficulty with pain management.
34. What more problems do we need as an anesthesiologist ?? Patients understand ( euphoria) what we explain ?? IV access , fluid deficits Airway Lungs Heart – especially autonomic !! Pain CognitionTemperature handling Poor wound healing
35. In PAC ?? Is it the time to go to the history of illicit drug expose regularly ?? YES Thank you all