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Intraoperative vasopressor use during emergency surgery on injured meth users
  1. Alexandra Marie Edwards1,
  2. Eric Gregory Johnson2,3,
  3. Andrew C. Bernard4
  1. 1Department of Obstetrics, Gynecology and Womens’s Health, St. Louis University, St. Louis, Missouri, USA
  2. 2Department of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
  3. 3Department of Pharmacy Practice, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
  4. 4Department of Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
  1. Correspondence to Dr Eric Gregory Johnson; eric.johnson{at}uky.edu

Abstract

Background Methamphetamine is a growing drug of abuse in America. Patients with recent methamphetamine use pose potential complications to general anesthesia due to changes in hemodynamics and arrhythmias. Limited data exists on the incidence of intraoperative complications on methamphetamine-intoxicated patients requiring urgent or emergent trauma surgery. This study aims to describe intraoperative complications observed in methamphetamine and amphetamine-intoxicated patients requiring emergent surgery.

Methods Using the Trauma Registry at our ACS-verified level I trauma center, we completed a single-center, descriptive, retrospective cohort review between July 1, 2012 and June 30, 2016, of adult patients requiring emergent surgery with a positive urine-drug screen for methamphetamines or amphetamines. The objective was to evaluate vasopressor utilization during surgical operation.

Results A total of 92 patients were identified with a positive UDS for amphetamine and/or methamphetamine who went to the operating room within 24 hours of admission. Thirty-two (34%) patients received one or more (≥1) doses of vasopressor, while 60 patients (66%) received no vasopressor. Changes in mean arterial pressure (MAP) were noted in 64%, while only 3% experienced an EKG change. A binomial logistic regression showed age, base deficit and change in MAP to be predictive of vasopressor use (p<0.002). No intraoperative cardiac events or anesthetic complications were seen.

Discussion Hemodynamic instability in the amphetamine and methamphetamine-intoxicated population may be more directly related to degree of resuscitation required, than the presence of a positive UDS.

Level of evidence IV

  • methamphetamine
  • hypotension
  • anesthesia
  • vasopressins
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Footnotes

  • Contributors AME and EGJ conducted the study design, data collection and statistical analysis. All authors contributed to writing, editing and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval A waiver of informed consent was granted by the IRB from University of Kentucky. The study/protocol number is 17-0101-P2H.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data are available as deidentified participant data on reasonable request.

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