![]() ![]() ![]() 11,13,14 Signs of Methamphetamine Intoxication According to Category Signs and Symptoms of Methamphetamine Intoxication. 11 Those intoxicated with methamphetamines experience a variety of signs and symptoms (table 1). The peripheral action of monoamines culminates in a diffuse and complex chain of systemic events. ![]() ![]() 12 These physiologic changes combined create an almost manic-depressive state in patients which can create a vicious cycle of misuse. Lastly, the scarcity of dopamine caused by the body’s inability to recover from the massive release of monoamines from storage vesicles causes feelings of depression and withdrawal which can further induce drug-seeking behaviors. 7-10 Methamphetamine also interacts with the endogenous opioid system further increasing endorphins in the nucleus accumbens which mediates reward centers. The release of dopamine into the nucleus accumbens follows the same pathway for natural rewards like social interaction, sex, eating, and exercise, but the stimulation from methamphetamine causes 2 to 10 times more dopamine to be released from endogenous stores than the natural rewards resulting in a dopamine release above 1000% basal levels. Once released, the monoamines bind to their appropriate postsynaptic receptors to affect a response. This pathway extends from ventral tegmental areas to the nucleus accumbens which is responsible for the euphoric feeling after using methamphetamine. Dopamine activates the mesolimbic, mesocortical tract, and nigrostriatal pathways. The International Union of Pure and Applied Chemistry (IUPAC) name for methamphetamine is (2S)-N-methyl-1-phenylpropan-2-amine.⁶ Though the mechanism of action is not fully understood, methamphetamine causes a release of the endogenous monoamines dopamine, norepinephrine, and serotonin (figure 1).įigure 1. The use of substances, like methamphetamine, has not gone away or decreased, but rather increased in frequency.⁴ It is important for each anesthesia professional to be aware of the potential lethal effects of methamphetamine use in the preoperative setting, the consequences of which may include hypertensive crisis, cardiovascular collapse from hypotension, and death.⁵ Adhering to practice from the most up to date literature may abate the potential morbidity and mortality and ensure the most appropriate care of patients with this particular SUD. Many patients who had previously maintained sobriety are now experiencing relapse due to increased stress, social isolation, and economic strain.⁴ It is important to remember that SUD still exist as an epidemic even during the pandemic. The COVID-19 pandemic also has the potential to increase the likelihood of encountering a patient with a SUD. A survey of 5,000 participants found that approximately 81% of patients provide false information to their providers regarding substance abuse.³ The most common reason given in the study was that patients did not want to be “judged.”³ Therefore, it would be prudent for an anesthesia professional to be aware that patients presenting for elective cases to the operating room may conceal the truth with regard to their illicit substance use. According to the National Institute on Drug Abuse, 0.6 percent of the population reported using methamphetamines.² That number is likely drastically under-reported due to the criminal nature and stigma related to diseases associated with drug use. Of the reported 329.9 million population of the United States in 2014, 21.5 million people were diagnosed with SUD.¹ Methamphetamine accounts for approximately 1.6 million of the 21.5 million individuals who misuse substances in this country. Substance Use Disorders (SUD) are a topic of increasing concern in the United States and continue to impact families and communities. This review article details medications and actions most appropriately suited for methamphetamine SUD patients who require anesthetic care. Managing these patients with appropriate medications and actions will help to reduce the risk of patients developing untoward effects. Patients who present with this particular SUD present with challenges for the anesthesia provider. Methamphetamine Substance Use Disorders (SUD) have been on the rise in the United States. ![]()
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