Chronic methamphetamine use

 

Acute:

Cardiovascular

·      Arrhythmias

·      Myocardial ischaemia

·      Stroke

Neurological

·      Seizures

·      Intracranial hypertension

·      Anaesthetic resistance

Behaviour

·      Violence

·      Unreliable historian

·      Unknown fasting status

·      Inability to consent for procedure

Management

·      Prefer to wait until offset (~8 hours)

·      Consider code grey

·      Premed: midazolam IV 0.075mg/kg vs PO 20mg

·      Induction: RSI

·      Analgesic: clonidine 1-2mcg/kg (anxiolytic)

·      Anti-emetic: droperidol 10mcg/kg (anti-psychotic, noting low dose)

 

Chronic:

Cardiovascular

·      Non-ischaemic cardiomyopathy

·      Catecholamine depletion

·      Adrenoceptor downregulation

·      Compensatory hypovolaemia

Neurological

·      Anaesthetic sensitivity

·      Stroke

·      Parkinson’s-like movement disorder

IVDU

·      Difficult IV access

·      Blood borne viruses / liver disease

·      Poor dentition (intubation damage)

·      Malnutrition (wound healing)

 

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