Acceso usuarios
Alejandro Millán Arrazola, Natalia Crespo Forcén, Iñaki Goiri García, Cristina López Esbec, José María Martínez Garcés, Ignacio Ladrero Paños
El incremento del consumo de cocaína y opioides constituye un desafío anestésico relevante. La cocaína ejerce un efecto simpaticomimético con riesgo de arritmias, hipertensión e isquemia miocárdica; los opioides, especialmente en exposición crónica, condicionan tolerancia, hiperalgesia inducida por opioides y dependencia física. Esta revisión sintetiza la evidencia para el manejo perioperatorio, incluyendo criterios para diferir cirugía en intoxicación aguda por estimulantes, continuidad de terapias con opioides de mantenimiento (metadona/buprenorfina) y estrategias de analgesia multimodal [1,2,4,5,7].
The rising prevalence of cocaine and opioid use poses major challenges for peri‑operative care. Cocaine produces a marked sympathetic surge leading to arrhythmias, hypertension and myocardial ischaemia, whereas chronic opioid exposure results in tolerance, hyperalgesia and physical dependence. This narrative review summarises current evidence on peri‑operative management of these patients. We discuss pathophysiological considerations, criteria for postponing elective procedures and optimisation strategies with emphasis on identifying acute intoxication, cardiovascular stability and pain control. Intra‑operative recommendations include balanced anaesthesia techniques, advanced haemodynamic monitoring, pharmacological treatment of cocaine‑induced hypertension and continuation of baseline opioid therapy to avoid withdrawal. Post‑operative priorities focus on respiratory surveillance, withdrawal management and prevention of cardiovascular complications. Implementation of structured protocols and multidisciplinary coordination is essential to improve outcomes in this high‑risk population.
