Anesthetic management in patients with problematic use of psychoactive substances undergoing surgery: case series in a colombian third-level health institution

Abstract

Introduction: The consumption of psychoactive substances (PAS) is an increasing public health problem worldwide due to its impact on morbidity, mortality, and healthcare costs. Patients with problematic substance use present a higher risk of medical and surgical complications as well as altered responses to anesthetic agents. Substances such as opioids, cocaine, and amphetamines can modify anesthetic requirements, cause intraoperative hemodynamic instability, and complicate perioperative pain management. Despite its clinical relevance, regional evidence regarding anesthetic management of patients with PAS use in high-complexity hospitals remains limited. This study aimed to characterize the anesthetic management of patients with problematic PAS use treated in a tertiary-level healthcare institution during 2023. Methods: An observational, descriptive, retrospective case-series study was conducted in a tertiary-level healthcare institution. Patients older than 18 years with documented PAS use identified through ICD-10 diagnoses or positive toxicological tests who underwent anesthetic evaluation or surgical intervention between January and June 2023 were included. Data were obtained through electronic medical record review and institutional databases. Descriptive analysis was performed for demographic variables, type of substance used, anesthetic management, and clinical complications. An exploratory association analysis was performed using Fisher’s exact test. Results: Five patients met the inclusion criteria. Eighty percent were male, with a mean age of 27.8 years. Three patients (60%) were homeless. The most frequently identified substances were heroin and cocaine (40% of each). Four patients (80%) underwent surgical procedures. Clinical complications occurred in three patients (60%), soft tissue infections, postoperative withdrawal syndrome, and electrolyte disturbances. Postoperative hyperalgesia was observed in three of the four surgical patients (75%). EDiscussion/Conclusion: Patients with problematic PAS use represent a clinically complex population in the perioperative setting, characterized by a high frequency of surgical interventions and medical complications. The high occurrence of postoperative hyperalgesia highlights the importance of multimodal analgesic strategies and comprehensive preoperative assessment. Although the small sample size limits generalization, these findings provide preliminary evidence regarding anesthetic management in this population and support the need for larger studies to optimize perioperative care for patients with psychoactive substance use