Prevalence of psychoactive substances as an anesthesiological problem
Keywords:psychoactive substances, amphetamine, mephedrone, cannabis, tetrahydrocannabinol, general anesthesia, review
AbstractThe problem of drug abuse is extremely actual these days; it is a big challenge for health care system. According to the UN data, about 275 million people around the world aged 15–64 years, which is about 5.6 % of the world’s population, has used illicit drugs at least once in 2016. According to WHO, 45,0000 people died because of drug use in 2015, including cases related to AIDS and hepatitis C. Last trend shows that a record level of herbal drug production was reached. The most popular drug is cannabis; amphetamines are on the second place. During the last few years, hundreds of novel synthetic drugs were synthesized and brought to market, the main amount of them are stimulants, cannabinoid receptor agonists, and classic hallucinogens. Last time there is a trend to increased use of novel synthetic drugs (derivatives of tetrahydrocannabinol and cations) by young adults. A large amount of new researches are dedicated to pharmacology and mechanism of action of novel synthetic drugs on human organism. A high rate of comorbid disorders associated with substance abuse, including those among youngs is observed. Cardiovascular complications hold a special place. Amphetamin has a cardiotoxic effect, induces dilatation cardiomyopathy, hemorrhagic stroke. Mephedrone, frequently used with alcohol, is characterized by typical sympathomimetic toxic syndome. According to WHO report on mephedrone, users of this drug can have related regressive dilatation cardiomyopathy, pneumomediastinum, subcutaneous emphysema, acute kidney disorders and recurrent posterior encephalopathic syndrome. Acute mephedrone intoxication leads to tachycardia, chest pain, seizures, headache; there are reported death cases. Synthetic cannabinoids compared to cannabis has stronger affinity to cannabinoid receptors type 2, due to their more pronounced toxicity. There are numbers of reported cases regarding acute miocardial infarction related to using spice among young people. Despite no angiogram signs of coronary pathology, myocardial infarction was induced by vasospasm. The most often cardial complication of using cannabis was myocardial infarction, as well as reported cases of arrhythmia, including atrial and ventricular fibrillation, stroke, peripheral arteriopathy, Takotsubo cardiomyopathy. Cannabis users showed variable response to propofol anesthesia compared to individuals who haven’t used cannabis. Propofol high doses were needed for conscious loss, adequate relaxation and depression of respiratory reflexes. Tetrahydrocannabinol was reported to prolong a sedative effect of general anesthesia on experimental models and was involved in development of perioperative complications, such as bronchospasm, tachycardia, uvula oedema. Either cannabis and tabacco smoking causes direct airway irritation. Cannabis use was also reported to be likely associated with diffuse alveolar haemorrhage in post-operative period. If sedative hypnotic drugs are used in cannabis users, excessive depression of the central nervous system may occur; therefore, barbiturates, opioids, and benzodiazepines are preferably avoided. Intraoperative and immediate postoperative doses of opiates for analgesia in patients with history of recent or chronic cannabis consumption may be significantly increased.
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