Perioperative considerations for patients exposed to hallucinogens

Abstract

Hallucinogen exposure in patients in the perioperative period presents challenges for anesthesiologists and other anesthesia providers. Acute and chronic exposure to these substances can cause physiological impacts that can affect the function of anesthetic and analgesic medications used during perioperative care. The objective of this narrative review is to educate readers on the wide array of hallucinogens and psychedelics that may influence the perioperative management of patients exposed to these substances. A narrative review of the literature surrounding hallucinogens and psychedelics was completed. Hallucinogens and psychedelics are quite varied in their mechanisms of action and therefore present a variety of perioperative implications and perioperative considerations. Many of these substances increase serotonin levels or act directly at serotonergic receptors. However, there are other relevant actions that may include varied mechanisms from N-methyl-D-aspartate receptor antagonism to stimulation of muscarinic receptors. With hallucinogen exposure rates on the rise, understanding the effects of hallucinogens is important for optimizing management and reducing risks perioperatively for patients with acute or chronic exposure.

Keywords: Drug-Related Side Effects and Adverse Reactions; Neurotransmitter Agents; Pharmacology.

Figure 1.. Hallucinogen Use Graph in Patient > 12 Years of Age from 2015 to 2019

Increase in Hallucinogen Use. Percent of people in the United States reporting using hallucinogens from 2015-2019. The percentage of the population using hallucinogens remains low. However, there continues to be a gradual rise in use of hallucinogens from 4.7 million in 2015 to 6 million in 2019 and this increase is likely to continue. Adapted from [3].