N 1 (186) 2024 р. P. 62–67

FEATURES OF ANESTHESIA PROVISION IN PATIENTS WITH METHAMPHETAMINE ADDICTION (LITERATURE REVIEW)

O. V. Kravets, V. V. Yekhalov, D. A. Krishtafor

Dnipro State Medical University, Dnipro, Ukraine

DOI 10.32782/2226-2008-2024-1-10

In Ukraine, there is a steady increase in the consumption of synthetic amphetamine-type drugs. Those drugs release stimulating neurotransmitters in the brain, which leads to psychokinetic changes, and cause strong addiction. Based on modern national and foreign medical reports, the purpose of the present study is to learn the components of anesthetic risk in patients who abuse MA, determine the least dangerous methods of anesthetic provision for the relevant category of patients, and consider ways of reducing the frequency of possible critical hemodynamic fluctuations and other serious anesthetic complications.

Results. If the patient seeks medical attention in a state of acute intoxication and/or after an overdose, it is advisable to delay surgery and anesthesia as long as safely possible to avoid a serious risk of hemodynamic instability. The most serious complications of chronic MA use are acute coronary syndrome, aortic dissection, rhabdomyolysis, acute kidney injury, intracerebral hemorrhage, hyperthermic syndrome, liver failure, cerebral circulation disorders, convulsions, and sudden death. Acute MA intoxication reduces the minimal alveolar concentration of the inhalation anesthetics, while chronic use increases it, reducing the dose for general anesthesia. If possible, it is advisable to choose regional anesthesia with ropivacaine. Ketamine, succinylcholine, and halothane are particularly undesirable drugs for the anesthetic support of operative interventions in MA-dependent patients. Amphetamine withdrawal syndrome can be difficult to recognize and can be confused with malignant hyperthermia during anesthesia. In some individuals, it lasts 24-48 hours. Treatment is provided at the intensive care unit.

Conclusion. Patients with MA dependence often have severe concomitant pathology and a high anesthetic and perioperative risk. Anesthetic management in such patients should include careful monitoring, suppression of psychomotor agitation, and management of possible hemodynamic instability. If possible, preference is given to regional methods of anesthesia or inhalation anesthetics. Contraindicated drugs are succinylcholine, halothane, and ketamine.

Key words: methamphetamine, drug addiction, complications, anesthesia, withdrawal syndrome.

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