Distorted Anesthetics of Medical Practice

Main Article Content

Saranya Lertkovit
Papiroon Noitasaeng
Ratthaya Kimura
Phongthara Vichitvejpaisal


Effortlessly, physicians rather than other professions
are about to close in upon psychotic drugs, and anesthesia
personnel become at the forefront of drug dependence.
Interestingly, drugs for anesthesia (inhalants and
non-inhalants) and analgesia are the most distorted
Commonly, misused Inhalants are ether, sevoflurane,
chloroform and nitrous oxide. Any factors-related to high
alveolar gas concentration results in rapid onset of action
and unconsciousness. Consequently, drugs have the
effects of ecstasy, delirium, drowsiness, amnesia and
respiratory depression. With high dose, it can cause
cardiac arrest; while abrupt halt produces drug withdrawal
Propofol, a non-inhalant, has fast induction and
recovery time. It results in a decreased level of
consciousness, euphoria, systemic vasodilatation,
depressed myocardium and the stopping of breathing.
Alternatively, ketamine induces hallucination, trance-like
state, muscle tremors, elevated blood pressure and
increased intracranial pressure. In addition, benzodiazepines
possess anxiolytic, sedative and amnesic actions. When
combined with morphine, it enhances severe respiratory
Morphine is an effective pain medication. It causes
elation, delusion, lethargy, chest wall muscle rigidity,
dysuria, nausea, vomiting, reducing gut motility and
causing constipation. However, a long-term use with high dose administration of morphine not quite alleviate pain
dramatically but addiction, tolerance and complications
such as depression, anxiety, insomnia and death by
respiratory depression.

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Special Articles


1. Jungerman FS, Alves HNP, Carmona MJC, Conti NB,
Malbergier A. Anesthetic drug abuse by anesthesiologists.
Rev Bras Anestesiol 2012;62:375-86.
2. Kaye AD, Jones MR, Kaye AM, et all. Prescription opioid
abuse in chronic pain: An updated review of opioid abuse
predictors and strategies to curb opioid abuse. Pain
Physician 2017;20:S93-S109.
3. Mayall RM. Substance abuse in anaesthetists. BJA Education
4. Alarcon AZ, Coffman JC, Soghomonyan S, Papadimos TJ,
Bergese SD, Moran KR. Non-opioid anesthetic drug abuse
among anesthesia care providers: a narrative review. Can J
Anesth 2017;64:169-84.
5. Grasshoff C, Rudolph U, Antkowiak B. Molecular and
systemic mechanisms of general anaesthesia: the ‘multi-site
and multiple mechanisms’ concept. Curr Opin Anaesthesiol
6. Mashour GA, Forman SA, Campagna JA. Mechanisms of
general anesthesia: from molecules to mind. Best Pract Res
Clin Anaesthesiol 2005;19:349-64.
7. Zacny JP, Galinkin JL. Psychotropic drug used in anesthesia
practice. Abuse liability and epidemiology of abuse.
Anesthesiology 1999;90:269-88.
8. Bryson EO, Silverstein JH. Addiction and substance in
anesthesiology. Anesthesiology 2008;190:907-17.
9. Khan KS, Hayes I, Buggy DJ. Pharmacology of anaesthetic
agent II: inhalation anaesthetic agents. Continuing Education
in Anaesthesia, Critical Care&Pain 2014;14:106-11.
10. National Institute on Drug Abuse. Inhalants [Internet]. 2019.
[Cited 2019 Dec 09]. Available from: https://www.drugabuse.
11. Perouansky M, Pearce R, Hemmings H, Jr. Inhaled
anesthetics: mechanisms of action. In: Miller RD, Eriksson
LI, Fleisher LA, Wiener-Kronish JP, Young WL, eds. Miller’s
Anesthesia, 7th edition. New York: Churchill Livingstone
Elsevier; 2010.
12. Sellers WFS. Misuse of anaesthetic gases. Anaesthesia
13. Duncum BM, Phil D. Ether anesthesia 1842-1900. Postgrad
Med J 1946;22:280-90.
14. Conway CM. The anaesthetic ethers. Br J Anaesth 1965;
15. Krenz S, Zimmermann G, Kolly S, Zullino DF. Ether: a
forgotten addiction. Addiction 2003;98:1167-8.
16. ScienceDirect. Chloroform; pharmacology and physiology
for anesthesia. 2nd Edition. 2019. [Internet] [Cited 2019 Dec
09]. Available from: https://www.sciencedirect.com/topic/
17. Todman D. James Young Simpson and the development of
obstetric anaesthesia. Int J Gynaecol Obstet 2007;10:1-5.
18. Dun PM. Sir James Young Simpson(1811-1870) and obstetric
anaesthesia. Arch Dis Child Fetal Neonatal Ed 2002;86:
19. Simpson JY. On a new anaesthetic agent, more efficient than
sulphuric ether. The Lancet 1847;50:549-50.
20. Payne JP. The criminal use of chloroform. Anesthesia 1998;
21. Butterworth JF, Mackey DC, Wasnick JD, editors. Inhalation
anesthetics. In: Morgan & Mikhail’s. Clinical Anesthesiology.
5th edition. New York: McGraw-Hill; 2013. p. 153-73.
22. Luo A, Zhang X, Li S. Sevoflurane addiction due to workplace
exposure: a case report and literature review. Medicine 2018;
23. Sethi NK, Mullin P, Torgovnick J, Capasso G. Nitrous Oxide
“ Whippit” abuse presenting with cobalamine responsive
psychosis. J Med Toxicol 2006;2:71-4.
24. Drug Rehab.com by Advanced Recovery Systems. Whippits:
10 facts about whippit abuse. 2018. [Internet]. [Cited 2019
Dec 09]. Available from: https://www.drugrehab.com/
25. Celine C, Gunter H, Kurt A. Laughing gas abuse is no joke.
An overview of the implications for psychiatric practice. Clin
Neurol Neurosurg. 2013;115:859-62.
26. Vasconcellos KD, Sneyd JR. Nitrous oxide: are we still in
equipoise? A qualitative review of current controversies. Br J
Anaesth 2013;111:877-85.
27. Buhre W, Disma N, Hendrickx J, et al. European Society of
Anaesthesiology Task Force on Nitrous Oxide: a narrative
review of its role in clinical practice. Br J Anaesth 2019; 122:
28. Randhawa G, Bodenham A. The increasing recreational use
of nitrous oxide: history revisited. Br J Anaesth 2016; 116:
29. Wilson C, Canning P, Caravati EM. The abuse potential of
propofol. Clin Toxicol 2010;48:165-70.
30. Xiong M, Shiwalkar N, Reddy K, Shin P, Bekker A. Neurobiology
of propofol addiction and supportive evidence: what is the
new development?. Brain Sci 2018;8:1-10.
31. Butterworth JF, Mackey DC, Wasnick JD, editors. Intravenous
anesthetics. In: Morgan & Mikhail’s. Clinical Anesthesiology.
5th edition. New York: McGraw-Hill; 2013. p. 175-88.
32. Li KY, Xiao C, Xiong M, Delphin E, Ye JH. Nanomolar propofol
stimulates glutamate transmission to dopamine neurons:
A possible mechanism of abuse potential?. J Pharmacol Exp
Ther 2008;325:165-74.
33. Pain L, Gobaille S, Schleef C, Aunis D, Oberling P. In vivo
dopamine measurements in the nucleus accumbens after
nonanesthetic and anesthetic dose of propofol in rats. Anesth
Analg 2002;95:915-9.
34. Riezzo I, Centini F, Neri M, et al. Brugada-like EKG pattern
and myocardial effects in a chronic propofol abuser. Clin
Toxicol 2009;47:358-63.
35. Monroe T, Hamza H, Stocks G, Scimeca PD, Cowan R. The
misuse and abuse of propofol. Subst Use & Misuse. 2011;
36. U.S.Department of justice Drug Enforcement Administration.
Schedule of controlled substances; placement of fospropofol
into schedule IV (21 CFR Part 1308). 2009;74:51234-6.
[Internet]. [Cited 2019 Dec 09]. Available from: https://www.
37. Pai A, Heining M. Ketamine. Continuing Education in
Anaesthesia Critical Care&Pain 2007;7:59-63.
38. Gales A, Maxwell S. Ketamine: recent evidence and current
uses. World Anaesthesia Tutorial of the week 2018;381: 1-7.
[Internet]. [Cited 2019 Dec 09]. Available from: https://www.
39. Schmid RL, Sandler AN, Katz J. Use and efficacy of low-dose
ketamine in the management of acute postoperative pain: a
review of current techniques and outcomes. Pain 1999;82:
40. Annetta MG, Lemma D, Garisto C, Tafani C, Proietti R.
Ketamine: new indications for an old drug. Curr Drug Targets
41. Bell RF, Kalso EA. Ketamine for pain management. Pain Rep
2018; 3: e674. doi.org/10.1097/PR9.0000000000000674.
42. Haas DA, Harper DG. Ketamine: a review of its pharmacologic
properties and use in ambulatory anesthesia. Anesth Prog
43. Kolawole IK. Ketamine hydrochloride: a useful but frequently
misused drug. Niger J Surg Res 2001;3:118-25.
44. Sleigh J, Harvey M, Voss L, Denny B. Ketamine-more
mechanisms of action than just NMDA blockade. Trends
Anaesthesia Critical Care 2014;4:76-81.
45. Hirota K, Lambert DG. Ketamine: news for an old drug?. Br
J Anaesth 2011; 107: 123-6.
46. Gahlinger PM. Club drugs: NMDA, gamma-hydroxybutyrate
(GHB), rohyphol, and ketamine. Am Fam Physician 2004;
47. Girard AL, Senn CY. The role of the new date rape drugs in
attributions about aate rape. J Interpers Violence 2008;23:
48. Williams JF, Lundahl LH. Focus on adolescent use of club
drugs and “ other” substances. Pediatr Clin N Am 2019;66:
49. Center for Substance Abuse Research. Ketamine [Internet].
[Cited 2019 Dec 09]. Available from: http://www.cesar.umd.
50. Zhu W, Ding Z, Zhang Y, Shi J, Hashimoto K, Lu L. Risks
associated with misuse of ketamine as a rapid-acting
antidepressant. Neurosci Bull 2016;32:557-64.
51. Li JH, Vicknasingam B, Cheung YW, et al. To use or not use:
an update on licit and illicit ketamine use. Subst Abuse
Rehabil 2011;2:11-20.
52. Schmitz A. Benzodiazepine use, misuse, and abuse:
a review. Ment Health Clin 2016;6:120-6.
53. Jones CM, McAninch JK. Emergency department visits and
overdose deaths from combined use of opioids and
benzodiazepines. Am J Prev Med 2015;49:493-501.
54. Umbricht A, Velez ML. Benzodiazepine abuse and addiction.
In: el-Guebaly N, Carrà G, Galanter M. eds. Textbook of
Addiction Treatment: International Perspectives. Milano:
Springer; 2015. doi.org/10.1007/978-88-470-5322-9_102
55. Hayhoe B, Lee-Davey J. Tackling benzodiazepine misuse.
Br Med J 2018;362:k3208.
56. Al-Hasani R, Bruchas MR. Molecular mechanisms of opioid
receptor-dependent signaling and behavior. Anesthsiology
57. Butterworth JF, Mackey DC, Wasnick JD, editors. Analgesic
agent. In: Morgan & Mikhail’s. Clinical Anesthesiology. 5th
edition. New York: McGraw-Hill; 2013. p. 189-98.
58. Webster LR. Risk factors for opioid-use disorder and
overdose. Anesth Analg 2017;125:1741-8.
59. Cheatle MD. Review articles prescription opioid misuse,
abuse, morbidity, and mortality: balancing effective pain
management and safety. Pain Medicine 2015;16:S3-S8.
60. Garg RK, Fulton-Kehoe D, Franklin GM. Patterns of opioid
use and risk of opioid overdose death among medicaid
patients. Medical Care 2017;55:661-8.
61. Koepke EJ, Manning EL, Miller TE, Ganesh A, Williams DGA.
The rising tide of opioid use and abuse: the role of the
anesthsiolgist. Perioperative Medicine 2018;7:1-10.
62. Bryson EO. The opiod epidemic and the current prevalence
of substance use disorder in anesthesiologists. Curr Opin
Anesthesiol 2018;31:388-92.
63. Silverstein JH, Silva DA, Iberti TJ. Opioid addiction in
anesthesiology. Anesthesiology 1993;79:354-75.
64. Amsterdam JV, Brink WZD. The misuse of prescription
opioids: a threat for Europe?. Current Drug Abuse Reviews