Anestesia e o usuário de Ecstasy

Eduardo Toshiyuki Moro; Alexandre A. Fontana Ferraz; Norma Sueli Pinheiro Módolo

doi:10.1590/S0034-70942006000200010

Artigo de Revisão

Anestesia e o usuário de Ecstasy

Anesthesia and the Ecstasy user

Eduardo Toshiyuki Moro; Alexandre A. Fontana Ferraz; Norma Sueli Pinheiro Módolo

http://dx.doi.org/10.1590/S0034-70942006000200010 Braz J Anesthesiol, vol.56, n2, p.183-188, 2006

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Resumo

JUSTIFICATIVA E OBJETIVOS: Nos últimos anos o número de novos usuários de agentes ilícitos tem aumentado de forma significativa em todo o mundo. A maconha e a cocaína, além do álcool e do tabaco, têm sido os agentes citados com freqüência, porém houve um aumento significativo de usuários de outros agentes psicoestimulantes ou alucinógenos, como o Ecstasy, o GHB, o LSD e a metanfetamina, empregados com o objetivo de intensificar as experiências sociais. O objetivo do presente artigo foi discutir a apresentação clínica, os efeitos deletérios e as potenciais interações com o ato anestésico no paciente cirúrgico usuário desses agentes ilícitos. CONTEÚDO: O artigo discute os mecanismos de ação, a apresentação clínica, os efeitos deletérios e as possíveis repercussões observadas durante a anestesia no usuário de MDMA (3,4-metilenodioximetanfetamina), também conhecido como Ecstasy. CONCLUSÕES: A apresentação clínica e os efeitos deletérios provocados pelo 3,4-metilenodioximetanfetamina (Ecstasy), assim como potenciais interações com o ato anestésico devem ser do conhecimento do anestesiologista, pois em muitas situações esses usuários serão submetidos a intervenções cirúrgicas de emergência, ou mesmo eletivas.

Palavras-chave

COMPLICAÇÕES, FARMACOLOGIA

Abstract

BACKGROUND AND OBJECTIVES: The number of new users of illicit substances has been growing steadily all over the world over the last few years. Marijuana and cocaine have been mentioned most often, but the last few years saw a marked increase in the number of users of other psychostimulants or hallucinogens, taken with the aim of intensifying social experiences. The aim of this article is to discuss the clinical presentation, the damaging effects and the potential interactions with anesthesia of the surgical patient who is a user of these illicit substances. CONTENTS: The article discusses the action mechanisms, the clinical presentation, the damaging effects and the potential repercussions observed during anesthesia in users of MDMA (3,4-methylenedioxymethamphetamine), also known as Ecstasy. CONCLUSIONS: Anesthesiologists should be made aware of the clinical presentation and the damaging effects brought about by 3,4 - methylenedioxymethamphetamine (Ecstasy), as well as the potential interactions with anesthesia, since people who use these substances may find themselves in surgery many times, either due to an emergency situation or by choice.

Keywords

COMPLICATIONS, PHARMACOLOGY

Referências

Hernandez M, Birnbach DJ, van Zundert AJC. Anesthetic management of the illicit-substance-using patient. Curr Opin Anaesthesiol. 2005;18:315-324.

Parks KA, Kennedy CL. Club drugs: reasons for and consequences of use. J Psychoactive Drugs. 2004;36:295-302.

Demetriades D, Gkiokas G, Velmahos GC. Alcohol and illicit drugs in traumatic deaths: prevalence and association with type and severity of injuries. J Am Coll Surg. 2004;199:687-692.

Milroy CM. Ten years of "Ecstasy". J R Soc Med. 1999;92:68-71.

Substance abuse and mental health services administration. .

Ferigolo M, Machado AGS, Oliveira NB. Ecstasy intoxication: the toxicological basis for treatment. Rev Hosp Clin Fac Med. 2003;58:332-341.

de Almeida SP, Silva MT. History, effects and mechanisms of action of ecstasy (3,4-methylenedioxyamphetamine): review of literature. Rev Panam Salud Publica. 2000;8:393-402.

Shulgin AT. The background and chemistry of MDMA. J Psychoactive Drugs. 1986;18:291-304.

Kish SJ. How strong is the evidence that brain serotonin neurons are damaged in humans users of ecstasy?. Pharmacol Biochem Behav. 2002;71:845-855.

Steadman JL, Birnbach DJ. Patients on party drugs undergoing anesthesia. Curr Opin Anaesthesiol. 2003;16:147-152.

Vollenweider FX, Gamma A, Liechti M. Psychological and cardiovascular effects and short-term sequela of MDMA ("ecstasy") in MDMA naive health volunteers. Neuropsychopharmacoly. 1998;19:241-251.

Ferigolo M, Medeiros FB, Barros HM. Ecstasy: a pharmacological review. Rev Saúde Publica. 1998;32:487-495.

Solowij N, Hall W, Lee N. Recreational MDMA use in Sydney: a profile of "Ecstasy" users and the experiences with the drug. Br J Addict. 1992;87:1161-1172.

de Almeida SP, Silva MT. Ecstasy (MDMA): effects and patterns of use reported by users in São Paulo. Rev Bras Psiquiatr. 2003;25:11-17.

Dar KJ, McBrien ME. MDMA induced hyperthermia: report of a fatality and review of current therapy. Intensive Care Med. 1996;22:995-996.

Green AR, Cross AJ, Goodwin GM. Review of the pharmacology and clinical pharmacology of 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"). Psychopharmacology. 1995;119:247-260.

Fiege M, Wappler F, Weisshorn R. Induction of malignant hyperthermia in susceptible swine by 3,4-methylenedioxymethamphetamine ("ecstasy"). Anesthesiology. 2003;99:1132-1136.

Rusyniak DE, Banks ML, Mills EM. Dantrolene use in 3,4-methylenedioxymethamphetamine ("Ecstasy")-mediated hyperthermia. Anesthesiology. 2004;101:263-264.

Campbell S, Qureshi T. Taking ecstasy... it´s child´s play!. Pediatric Anesth. 2005;15:257-259.

Klein M, Kramer F. Rave drugs: pharmacological considerations. AANA J. 2004;72:61-67.

Henry JA. Metabolic consequences of drug misuse. Br J Anaesth. 2000;85:136-142.

Reneman L, Habraken JB, Majoie CB. MDMA ("Ecstasy") and its association with cerebrovascular accidents: preliminary findings. Am J Neuroradiol. 2000;21:1001-1007.

Greydanus DE, Patel DR. Substance abuse in adolescents: a complex conundrum for the clinician. Pediatr Clin North Am. 2003;50:1179-1223.

Kain ZN, Barash PG. Anesthetic implications of drug abuse. ASA Refresher Courses. 2001;29:159-173.

Gill JR, Hayes JA, de Souza IS. Ecstasy (MDMA) deaths in New York City: a case series and review of the literature. J Forensic Sci. 2002;47:121-126.

Richards JR. Rhabdomyolisis and drugs abuse. J Emerg Med. 2000;19:51-56.

O'Cain PA, Hletko SB, Ogden BA. Cardiovascular and sympathetic responses and reflex changes elicited by NMDA. Physiol Behav. 2000;70:141-148.

Kuczkowski KM. Anesthetic implications of drug abuse in pregnancy. J Clin Anesth. 2003;15:382-394.

Anestesia e o usuário de Ecstasy

Anesthesia and the Ecstasy user

Eduardo Toshiyuki Moro; Alexandre A. Fontana Ferraz; Norma Sueli Pinheiro Módolo

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