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“Robo-Tripping”: Dextromethorphan Abuse and its Anesthetic Implications

AUTHORS

Kelly A Linn 1 , Micah T Long 1 , Paul Pagel 1 , *

1 Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA

How to Cite: Linn K A, Long M T, Pagel P. “Robo-Tripping”: Dextromethorphan Abuse and its Anesthetic Implications, Anesth Pain Med. 2014 ; 4(5):e93363. doi: 10.5812/aapm.20990.

ARTICLE INFORMATION

Anesthesiology and Pain Medicine: 4 (5); e93363
Published Online: November 13, 2014
Article Type: Case Report
Received: May 11, 2019
Accepted: July 06, 2014
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Abstract

Introduction: We describe a patient scheduled for elective surgery who regularly consumed approximately 12 to 15 times the maximum recommended daily dose of dextromethorphan. We describe the clinical pharmacology of dextromethorphan and discuss its anesthetic implications.

Case Presentation: A 30-year-old man with a history of a nasal fracture was scheduled to undergo an elective septorhinoplasty. He reported daily consumption of large quantities (1440 to 1800 mg) of dextromethorphan for six years. He was previously treated for dextromethorphan dependency on several occasions with urine dextromethorphan levels exceeding 2000 ng/mL. He described marked dissociative effects when abusing the drug, but had abstained from use for 48 hours before his elective surgery. Considering that dextromethorphan has a relatively short half-life and that the patient did not suffer major withdrawal symptoms after voluntarily discontinuing the drug, the authors proceeded with the case while recognizing that the drug has significant neuropsychiatric and sympathetic nervous system stimulant effects resulting from its actions as a N-methyl-D-aspartate receptor antagonist.

Conclusions: Anesthesiologists need to be aware of dextromethorphan’s clinical pharmacology because recreational abuse of the drug has become increasingly common in adolescents and young adults.

Keywords

Dextromethorphan Sigma Opioid Receptor Substance Abuse Addiction Dissociative Anesthesia NMDA Receptor Antagonists

© 2014, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

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