Anesthesia abuse

Sensory systems Topical ocular anesthesia abuse is often misdiagnosed as acanthamoeba keratitis (a parasitic disease) and early identification to prevent ocular complications including superficial pxmctate keratitis, persistent epithelial defects, stromal/ring infiltrates, comeal oedema, endothelial damage and ocular inflammation is important. Local anesthetics may cause direct toxicity to the comeal epithelium, stroma and endothelium. Preservatives in the anesthetics may also contribute to toxicity. Patient demographics may include a health care association and/or psychiatric illness [25 ]. Evisceration of the eye after persistent topical anesthetic use has been described [26 ]. 

The most important fluorinated benzodiazepine, flurazepam (21) has found considerable use (and abuse) as a hypnotic [I4 Flumazenil (22) is a fast-acting antidote in the treatment of benzodiazepine intoxication and m the reversal of the CNS effects of benzodiazepines dunng anesthesia [f<5,19]... 

Fadda F, Columbo G, Mosca E, et al Suppression by gamma-hydroxybutyric acid of ethanol withdrawal syndrome in rats. Alcohol Alcohol 24 447-451, 1989 Fine J, Finestone SC. Sensory disturbances following ketamine anesthesia recurrent hallucinations. Anesth Analg 52 428 30, 1973 Freese TE, Miotto K, Reback CJ The effects and consequences of selected club drugs. J Subst Abuse Treat 23 151—156, 2002... 

Sodium oxybate is effective and indicated for the treatment of cataplexy in patients with narcolepsy it could also be effective for general anesthesia, narcolepsy, fibromyalgia syndrome, insomnia, alcoholism and opiate withdrawal, but its potential for abuse is unacceptable... 

The natural substance cocaine was already beeing employed for local anesthesia in ophthalmological surgery in 1884 (Vandam, 1987). However, the clinical use of cocaine is limited because of its abuse potential, its intense vasoconstriction and eventual arrhythmias due to its reuptake-inhibition of catecholamines, and instability upon sterilization. The chemical search for synthetic substitutes started in 1892 and gave rise to several compounds without abuse potential and with improved onset and duration of action, tolerability and stability of the preparation. 

Ketamine, a weakly basic compound structurally and pharmacologically similar to phencyclidine, is utilized in the U.S. to induce anesthesia.1 It is available in solution for intravenous or intramuscular injection. Since the drug is pharmacologically similar to PCP it has the potential of producing hallucinogenic effects and, therefore, in recent years has become a drug of abuse. 

The ultrashort-acting barbiturates methohexital (Bre-vital), thiamylal (Surital), and thiopental (Pentothal) are administered as an anesthetic before surgery. The barbiturate is injected into the patient s vein to induce anesthesia. The patient then receives a longer-acting anesthetic like nitrous oxide. The drugs are used in hospital settings and are not subject to abuse, according to the DEA. 

Inhalant abuse refers to the intentional inhalation of such products to experience a carefree, euphoric high. The exact mind-altering effects of inhalants vary, depending on the product involved, but they are generally similar to those produced by alcohol intoxication or anesthesia. The health ramifications can be serious, in both the short and long term, because most inhalants are highly toxic. 

Inhalant abuse can also be a hazard in some occupations. People who work in the refrigeration industry may abuse Freon, hydrocarbons used in refrigerants and people working in medical fields may abuse nitrous oxide. A 1979 study, Abuse of Nitrous Oxide, published in Anesthesia Analgesia, found that 20% of dental and medical students had abused nitrous oxide. 

Ketamine (Figure 25-2) produces dissociative anesthesia, which is characterized by catatonia, amnesia, and analgesia, with or without actual loss of consciousness. The drug is an arylcyclohexylamine chemically related to phencyclidine (PCP), a drug frequently abused because of its psychoactive properties. The mechanism of action of ketamine may involve blockade of the... 

A 37-year-old man who had abused metamfetamine, paint thinner, psychotomimetic drugs, and alcohol for 20 years was given chlorpromazine, haloperidol, and fluni-trazepam just before surgery. After spinal anesthesia he was given propofol 5 mg/kg/hour intravenously. However, euphoria and excitement occurred 10 minutes after the start of the infusion and he had excitement, hallucinations, and delirium. His symptoms were suppressed by intravenous haloperidol 5 mg. 

DOT CLASSIFICATION Forbidden SAFETY PROFILE A human poison by ingestion and possibly other routes. Poison experimentally by ingestion, intraperitoneal, intravenous, subcutaneous, and parenteral routes. Human central nervous system effects by ingestion and possibly other routes general anesthesia, hallucinations or distorted perceptions, and convulsions. An eye irritant. A widely abused, controlled substance. Abuse leads to habituation or addiction. In medicine, it is used as a local narcotic anesthetic applied topically to mucous membranes. The free base is soluble... 

The immediate effects of inhalant abuse are similar to the classic early stages of anesthesia. The sniffer is initially stimulated, excited, disinhibited, and prone to impulsive or reckless behavior. He may also feel lightheaded and, with successive inhalations, less inhibited and less in control. The speech of the user becomes slurred and gait becomes staggered, with similarities to intoxication by alcohol. Euphoria, often accompanied by hallucinations, also may... 

Coca-Cola was originally flavored with extracts from the leaves of the coca plant and the kola nut. Coca is grown in northern South America the Indians of Peru and Bolivia have for centuries chewed the leaves to relieve the pangs of hunger and high mountain cold. The cocaine from the leaves causes local anesthesia of the stomach. It has limited use as a local anesthetic for surgery on the eye, nose, and throat. Unfortunately it is now a widely abused illicit drug. Kola nuts contciin about 3% caffeine as well as a number of other alkaloids. The kola tree is in the same family as the cacao tree from which cocoa cmd chocolate cu-e obtained. Modem cola drinks do not contain cocaine however, Coca-Cola contains 43 mg of caffeine per... 

Cocaine is used for topical local anesthesia of mucous membranes. It is also a drug of abuse. 

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