Anaesthetic implications of drug abuse in trauma patients

  • M. J. A. Parr
  • R. J. H. Hadfield
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


It is increasingly recognised that drug abuse not only contributes to the trauma patient population but also that the effects of acute and chronic drug toxicity have major implications for patient management. The role of drug abuse as a factor associated with morbidity and mortality in the trauma setting has not been properly quantified. Physicians dealing with victims of acute trauma will however, inevitably have to deal with the associated problems of drug abuse. For optimal management of these patients a thorough working knowledge of commonly abused drugs is required.


Trauma Patient Cocaine Abuse Anaesthetic Requirement Trauma Setting Malignant Hyperpyrexia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Government Statistical Service (1997) Statistical bulletin. Department of Health, p 1.Google Scholar
  2. 2.
    Kirby JM, Maull KI, Fain W (1992) Comparability of alcohol and drug use in injured drivers. Southern Med Journal 85:800–801.CrossRefGoogle Scholar
  3. 3.
    Lindenbaum GA, Carrol SF, Daskal I et al (1989) Patterns of alcohol and drug abuse in an urban trauma center: the increasing role of cocaine abuse. J Trauma 29:1654–1658.PubMedCrossRefGoogle Scholar
  4. 4.
    Soderstrom CA, Dischinger PC, Smith GS et al (1992) Psychoactive substance dependence among trauma center patients. JAMA 267:2756–2759PubMedCrossRefGoogle Scholar
  5. 5.
    Department of Transport (1997) News release, press notice 149/Transport.Google Scholar
  6. 6.
    Galbraith S (1976) Misdiagnosis and delayed diagnosis of traumatic intracranial haematoma. British Medical Journal 1:1438.PubMedCrossRefGoogle Scholar
  7. 7.
    Abelson HI, Miller JD (1985) A decade in trends in cocaine use in the household population. Nat Inst Drug Abuse Res Monogr Ser 61:35–49.Google Scholar
  8. 8.
    Marzuk PM, Tardiff K, Leon AC et al (1995) Fatal injuries after cocaine use as a leading cause of death among young adults in New York City. N Eng J Med 26:1753.CrossRefGoogle Scholar
  9. 9.
    Pasternack PF, Colvin SE, Baumann FG (1985) Cocaine induced angina pectoris and myocardial infarction in patients younger than 40 years. Am J Cardiol 55:847.PubMedCrossRefGoogle Scholar
  10. 10.
    Isner JM, Estes M, Thompson PD et al (1986) Acute cardiac events temporarily related to cocaine abuse. N Engl J Med 315:1438.PubMedCrossRefGoogle Scholar
  11. 11.
    Barth CW, Bray M, Roberts WC (1986) Rupture of the ascending aorta during cocaine intoxication. Am J Cardiol 57:496.PubMedCrossRefGoogle Scholar
  12. 12.
    Chokshi SK, Moore R, Pondion NG et al (1989) Reversible cardiomyopathy associated with cocaine intoxication. Ann Intern Med 111:1039.PubMedGoogle Scholar
  13. 13.
    Lange RA, Cigarroa RG, Yancy CW Jr et al (1989) Cocaine induced coronary artery vasoconstriction. N Eng J Med 321:1557–1562.CrossRefGoogle Scholar
  14. 14.
    Cregler LL, Mark H (1986) Cardiovascular dangers of cocaine abuse. Am J Cardiol 57:1185.PubMedCrossRefGoogle Scholar
  15. 15.
    Lange RA, Cigarroa RG, Flores ED et al (1990) Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade. Ann Intern Med 112:897–903.PubMedGoogle Scholar
  16. 16.
    Ramoska E, Sacchetti AD (1985) Propranolol-induced hypertension in treatment of cocaine intoxication. Ann Emerg Med 14:1112.PubMedCrossRefGoogle Scholar
  17. 17.
    Gay GR, Loper KA (1988) The use of labetolol in the management of cocaine crisis. Ann Emerg Med 17:282–283.PubMedCrossRefGoogle Scholar
  18. 18.
    Dusenberry SJ, Hicks MJ, Mariani PJ (1987) Labetalol treatment of cocaine toxicity. Ann Emerg Med 16:235.PubMedCrossRefGoogle Scholar
  19. 19.
    Pollan S, Tadjziechy M (1989) Esmolol in the management of epinephrine and cocaine induced cardiovascular toxicity. Anesth Analg 69:663–664.PubMedCrossRefGoogle Scholar
  20. 20.
    Derlet RW, Albertson TE (1990) Potentiation of cocaine toxicity with lidocaine. Ann Emerg Med 19:464.Google Scholar
  21. 21.
    Itkonen J, Schnoll S, Glassroth J (1984) Pulmonary dysfunction in “freebase” cocaine users. Arch Int Med 144:2195.CrossRefGoogle Scholar
  22. 22.
    Shesser R, Davis C, Edelsten S (1981) Pneumomediastinum and pneumothorax after inhaling alkaloidal cocaine. Ann Emerg Med 10:213.PubMedCrossRefGoogle Scholar
  23. 23.
    Patal RC, Dutta D, Schonfeld SA (1987) Free-base cocaine use associated with bronchiolitis obliterans organizing pneumonia. Ann Intern Med 107:186.Google Scholar
  24. 24.
    Campbell D, Parr MJA, Shutt LE (1996) Unrecognised crack cocaine abuse in pregnancy. Br J Anaesthesia 77:553–555.CrossRefGoogle Scholar
  25. 25.
    Derlet RW, Albertson TE (1986) Emergency department presentation of cocaine intoxication. Ann Emerg Med 18:182.CrossRefGoogle Scholar
  26. 26.
    Seaman ME (1990) Acute cocaine abuse associated with cerebral infarction. Ann Emerg Med 19:34.PubMedCrossRefGoogle Scholar
  27. 27.
    Lichtenfeld PJ, Rubin DB, Feldman RS (1984) Subarachnoid hemorrhage precipitated by cocaine snorting. Arch Neurol 411:223.CrossRefGoogle Scholar
  28. 28.
    Peterson PL, Roszler M, Jacobs I et al (1991) Neurovascular complications of cocaine abuse. J Neuropsychiat Clin Neurosci 3:143.Google Scholar
  29. 29.
    Kay BR, Fainstate M (1987) Cerebral vasculitis associated with cocaine abuse. JAMA 258:2104.CrossRefGoogle Scholar
  30. 30.
    Myers JA, Barnett MF (1984) Generalized seizures and cocaine abuse. Neurology 344:1675.Google Scholar
  31. 31.
    Merigian KS, Roberts JR (1987) Cocaine intoxication: hyperyrexia, rhabdomyolysis, and acute renal failure. Clin Toxicol 25:135.CrossRefGoogle Scholar
  32. 32.
    Perinol LE, Warren GE, Levine JS (1987) Cocaine induced hepatoxicity in humans. Gastroenterology 93:176.Google Scholar
  33. 33.
    Stoelting RK, Creassor CW, Martz RC (1975) Effects of cocaine on halothane MAC in dogs. Anesth Analg 54:422.PubMedGoogle Scholar
  34. 34.
    Matera C, Warren WB, Moomjy M et al (1990) Prevalence of the use of cocaine and other substances in an obstetric population. Am J Obstet Gynecol 163:797.PubMedGoogle Scholar
  35. 35.
    Woods JR, Plessinger MA, Clark KE (1987) Effect of cocaine on uterine blood flow and fetal oxygenation. JAMA 257:957.PubMedCrossRefGoogle Scholar
  36. 36.
    Derlet RW, Albertson TE (1989) Agents that protect against cocaine induced death and seizures. Ann Emerg Med 18:446.CrossRefGoogle Scholar
  37. 37.
    Goetting MG (1985) Neurotoxicity of meperidine. Ann Emerg Med 14:1007.PubMedCrossRefGoogle Scholar
  38. 38.
    Stone PA, MacIntyre PE, Jarvis DA (1993) Norpethidine toxicity and patient controlled analgesia. BJA 71:738–740.PubMedCrossRefGoogle Scholar
  39. 39.
    Duberstein JL, Kaufman DM (1971) A clinical study of an epidemic of heroin intoxication and heroin induced pulmonary oedema. Am J Med 51:704PubMedCrossRefGoogle Scholar
  40. 40.
    National Safety Council (1996) Accident facts. National Safety Council, Itasca.Google Scholar
  41. 41.
    Goldfrank LR (1984) The several uses of naloxone. Emerg Med 16:105.Google Scholar
  42. 42.
    Tandberg D, Abercrombie D (1982) Treatment of heroin overdosage with endotracheal naloxone. Ann Emerg Med 11:443.PubMedCrossRefGoogle Scholar
  43. 43.
    George CF, Robertson D (1987) Clinical consequences of abrupt drug withdrawal. Med Toxicol 2:367.Google Scholar
  44. 44.
    Gossop M (1988) Clonidine and the treatment of the opioid withdrawal syndrome. Drug Alcohol Depend 21:253.PubMedCrossRefGoogle Scholar
  45. 45.
    Sweet AY (1982) Narcotic withdrawal syndrome in the newborn. Pediatr Rev 3:285.CrossRefGoogle Scholar
  46. 46.
    Johnstone RE, Lief PL, Kulp RA et al (1975) Combination of delta-9-tetrahydrocannabinol with oxymorphone and pentobarbital. Anesthesiology 42:674.PubMedCrossRefGoogle Scholar
  47. 47.
    Stoelting RK, Martz RC, Gartner J et al (1973) Effects of delta-9-tetrahydrocannabinol on halothane MAC in dogs. Anesthesiology 38:521.PubMedCrossRefGoogle Scholar
  48. 48.
    Parker H, Measham F, Aldridge J (1995) Drug futures. Changing patterns of drug use amongst English youth. Institute for the Study of Drug Dependence, London.Google Scholar
  49. 49.
    McMiller P, Plant M (1996) Drinking, smoking, and illicit drug use among 15 and 16 year olds in the United Kingdom. British Medical Journal 313:394–397.CrossRefGoogle Scholar
  50. 50.
    Rudat K, Speed M, Ryan H (1992) Today’s young adults: 16’19-year-olds look at alcohol, smoking, drugs and sexual behaviour. Health Education Authority, LondonGoogle Scholar
  51. 51.
    Rudnick G, Wall SC (1992) The molecular mechanism of “ecstasy” [3,4-methylene-dioxymethamphetamine (MDMA)]: serotonin transporters are targets for MDMA induced serotonin release. Proc Nat Acad Sci 89:1817–1821.PubMedCrossRefGoogle Scholar
  52. 52.
    Fuller RW, Hines CW, Mills J (1965) Lowering of brain Serotonin level by Chloramphetamines. Biochem Pharmacol 14:483–488.PubMedCrossRefGoogle Scholar
  53. 53.
    Pletscher A, Burkard WP, Brunderer H, Grey KF (1963) Decrease of cerebral 5-hydrox-ytryptamine and 5-hydroxyindolacetic acid by an arylalkylamine. Life Sciences 2:828–833.CrossRefGoogle Scholar
  54. 54.
    Johnson MP, Hoffman AJ, Nichols DE (1986) Effects of the enantiomers of MDA, MDMA and related analogues on [3H] serotonin and [3H]dopamine release from the superfused rat brain slices. Eur J Pharmacol 132:269–276.PubMedCrossRefGoogle Scholar
  55. 55.
    Nichols DE, Lloyd DH, Hoffman AJ, Nichols MB, Yim GKW (1982) Effects of certain hallucinogenic amphetamine analogues on the release of (3H) Serotonin from rat brain synaptosomes. J Med Chem 25:535–538.PubMedCrossRefGoogle Scholar
  56. 56.
    Schmidt CJ, Levin JA, Lovenberg W (1987) In vitro and in vivo neurochemical effects of methylenedioxymethamphetamine on striatal monoaminergic systems in the rat brain. Biochem Pharmacol 36:747–755.PubMedCrossRefGoogle Scholar
  57. 57.
    Clineschmidt BV, Totaro JA, McGuffin JC, Pflueger AB (1976) Fenfluramine: long-term reduction in brain Serotonin (5-hydroxytryptamine). Eur J Pharmacol 35:211–214.PubMedCrossRefGoogle Scholar
  58. 58.
    Ricaurte G, Bryan G, Strauss L, Seiden L, Schuster C (1985) Hallucinogenic amphetamine selectively destroys brain serotonin terminals. Science 229:986–988.PubMedCrossRefGoogle Scholar
  59. 59.
    McKenna DJ, Peroutka SJ (1990) Neurochemistry and neurotoxicity of 3,4 methylenedioxymethamphetamine (MDMA, “ecstasy”). J Neurochem 54:14–22.PubMedCrossRefGoogle Scholar
  60. 60.
    Dowling GP, McDonagh ET III, Bost RO (1987) Eve and Ecstasy. A report of five deaths associated with the use of MDEA and MDMA. JAMA 257:1615–1617.PubMedCrossRefGoogle Scholar
  61. 61.
    Henry JA, Jeffreys KJ, Dawling S (1992) Toxicity and deaths from 3,4-methylene-dioxymethamphetamine (Ecstasy). Lancet 340:384–387.PubMedCrossRefGoogle Scholar
  62. 62.
    Screaton GR, Singer M, Cairns HS, Thrasher A, Sarner M, Cohen SL (1992) Hyperpyrexia and rhabdomyolysis after MDMA (ecstasy) abuse. Lancet 339:677–678.PubMedCrossRefGoogle Scholar
  63. 63.
    Nimmo SM, Kennedy BW, Tullett WM, Blyth AS, Dougall JR (1993) Drug-induced hyperthermia. Anaesthesia 48:892–895.PubMedCrossRefGoogle Scholar
  64. 64.
    Singarajah C, Lavies NG (1992) An overdose of ecstasy. A role for dantrolene. Anaesthesia 47:686–687.PubMedCrossRefGoogle Scholar
  65. 65.
    Logan AS, Stickle B, O’Keefe N, Hewitson H (1993) Survival following ecstasy ingestion with a peak temperature of 42 degrees C. Anaesthesia 48:1017–1018.PubMedCrossRefGoogle Scholar
  66. 66.
    Webb C, Williams V (1993) Ecstasy intoxication: appreciation of complications and the role of dantrolene. Anaesthesia 48:542–543.PubMedCrossRefGoogle Scholar
  67. 67.
    Tehan B, Hardern R, Bodenham A (1993) Hyperthermia associated with 3,4-methyl-enedioxyethamphetamine (Eve). Anaesthesia 48:507–510.PubMedCrossRefGoogle Scholar
  68. 68.
    Rhodes PJ, Rhodes RS (1984) Elimination kinetics and symptomatology of diazepam withdrawal in abusers. Clin Toxicol 22:371.CrossRefGoogle Scholar
  69. 69.
    Marchant B, Wray R, Leach A, Nama M (1989) Flumazenil causing convulsions and ventricular tachycardia. Br Med J 299:860.CrossRefGoogle Scholar
  70. 70.
    Shulgin AT (1980) LSD. J Psychedelic Drugs 12:173.PubMedCrossRefGoogle Scholar
  71. 71.
    Khun DM, White FJ, Appel JB (1978) The discriminative stimulus properties of LSD: mechanisms of action. Neuropharmacology 17:257.CrossRefGoogle Scholar
  72. 72.
    McCarron MM, Schulze BW, Thompson GA (1981) Acute phencyclidine intoxication: clinical patterns, complications and treatment. Ann Emerg Med 10:290.PubMedCrossRefGoogle Scholar
  73. 73.
    Barton CH, Sterling ML, Vaziri ND (1981) Phencyclidine intoxication: clinical experience in 27 cases confirmed by urine assay. Ann Emerg Med 10:243PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • M. J. A. Parr
  • R. J. H. Hadfield

There are no affiliations available

Personalised recommendations