Anesthetic risks in illicit drug users: A narrative literature review
DOI:
https://doi.org/10.33448/rsd-v15i1.50573Keywords:
Anesthesia, Illicit drugs, Surgical procedures, Risks.Abstract
Introduction: The increasing consumption of illicit drugs represents a significant challenge for anesthetic practice due to the physiological, pharmacokinetic, and pharmacodynamic alterations associated with these substances. Acute or chronic use can modify the response to anesthetic agents, increasing the risk of perioperative adverse events and hindering clinical decision-making by the anesthesiologist. Objective: To review the literature on the risks and main anesthetic complications associated with the use of illicit drugs, as well as to discuss perioperative management strategies described for this population. Methodology: A narrative literature review was conducted in the PubMed/MEDLINE, SciELO, EBSCOhost, and Google Scholar databases, selecting articles published between 2014 and 2025, in Portuguese, English, and Spanish. Studies addressing the interaction between illicit drugs and anesthesia, focusing on perioperative complications, pharmacological alterations, and anesthetic management strategies, were included. Results: Drug users have a higher incidence of hemodynamic instability, arrhythmias, respiratory depression, analgesia resistance, and drug interactions in the perioperative period. Substances such as cannabis, cocaine, crack, amphetamines, and opioids are associated with unpredictable responses to general and local anesthetics, especially in situations of recent use and in emergency surgeries, where preoperative assessment is limited. Conclusion: Anesthetic management in these patients requires careful assessment of the history of drug use, rigorous monitoring, and individualization of anesthetic strategies. Continuous training of professionals, combined with the use of multimodal approaches and evidence-based protocols, is essential to reduce complications and ensure greater perioperative safety in this population.
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