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Substance Abuse - Ecstasy (MDMA)

Anesthesia Implications

Anesthesia Implications

Ecstasy is otherwise known as 3,4-methylenedioxymethamphetamine (MDMA) Detection window - 48 hours. Screening is difficult. Drug effects - tremulousness, anxiety, agitation, and palpitation. Watch carefully for arrhythmias. stroke, seizures, myocardial infarction, and sudden death have also been seen in patients abusing this drug. Toxicity - manifests as nausea, tachycardia, hyperthermia, hypertension, polydipsia, anxiety, bruxism, and fatal effects like disseminated intravascular coagulation (DIC), seizures, or death. Be aware that polydipsia can lead to hyponatremia. Treatment - treat hypertension and tachycardia with benzodiazepines. Cooling measures should be employed if the patient is hyperthermic. False positives - Pseudoephedrine, Vicks inhaler

Pathophysiology

Ecstacy is an amphetamine derivative that results in serotonin, dopamine, and norepinephrine release along with monoamine oxidase (MOA) inhibition. This drug is rarely taken in isolation. Other names - X, M, E XTC, Rolls, Clarity, Adam, Lover's speed, and hug drug. Routes - oral ingestion, IV, snorting. Recreational Effects - euphoria, hallucinations, increased sexual and social interest


Reference

Haldar. Rave drugs and anesthesiology practice: A pharmacoclinical review. 2015.
Moran. Perioperative management in the patient with substance abuse. 2015.