Cancellation – Methamphetamine abuse is a common reason to cancel an elective surgery. Be sure to reference your facility protocols.

Detection window – 48 hours

Prescription Amphetamines – should be continued throughout the perioperative period

False positives – Ephedrine, pseudoephedrine, amantadine, labetalol

Minimum alveloar concentration (MAC) – reduced with acute intoxication. Increased with chronic use

Airway – a thorough assessment of the airway should be done prior to surgery to assess for loose/missing teeth. Document thoroughly. If methamphetamine is snorted, septal necrosis can occur, which would be a major consideration before placing NG tubes.

Hemodynamics – Labile blood pressure. Patient may be hyper/hypotensive. Typically refractory hypotension. Be aware that hemodynamic compromise is possible – especially in those who are unable to undergo a thorough preoperative workup. Because of the reduction in catecholamines, direct vasopressors (ie. phenylephrine & epinephrine) are recommended to treat refractory hypotension.

Cardiac – workup should absolutely include a recent EKG. Chronic users should have an echocardiogram if time permits.

Withdrawal – peaks at 24 hours after the last use. Symptoms include central nervous system depression, mood depression, increased eating/sleeping. There’s no consensus as to the best treatment.

Substance abuse (general considerations) – If necessary, get your urine/blood screen early. The urine screen will take 30 minutes and a serum screen will be closer to an hour. Almost all drug screens will return results for marijuana, amphetamines/methamphetamines, phencyclidine (PCP), cocaine, opioids, barbiturates, and benzodiazepines. Generally speaking, if the patient is acutely intoxicated, the case should be cancelled/delayed. Refer to your facility to get policies on cancellations/delays.

Abuse of this drug can be done by ingesting, snorting, smoking, or injecting.

Cardiac – methamphetamine abuse can lead to arrhythmias, aortic dissection, cardiomyopathy, myocardial ischemia, acute coronary syndrome.

Respiratory – Inhaled use can lead to pulmonary toxicity and remodeling. Pulmonary hypertension may also result.

Endocrine – Reduced catecholamines