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.
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
