Kratom and Anesthesia

Abstract

Kratom, known as Mitragyna speciosa (Korth), is a native plant in Thailand and Southeast Asia. It is used as a drug of abuse, opioid alternative, or pain killer. The pharmacokinetics of this plant has been studied only in animals, and there are no such studies in humans. Kratom contains pharmacologically active ingredients, most particularly mitragynine and 7-hydroxy- mitragynine. Kratom leaves contain multiple psychoactive chemicals that stimulate opioid, alpha-2, and serotonergic receptors. It produces complex stimulant and opioid-like analgesic effects. Therefore, it is used to treat pain and to alleviate opioid withdrawal or as an opioid replacement among people with opioid use disorder. Kratom is one of abuse drugs including tobacco and cannabis.1,2 It is illegal in many countries. Conventionally, kratom could be smoked, vaporized, or consumed as a powder. Several patients who consume kratom require medical intervention and care by anesthesiologists. Importantly, kratom users are of direct concerns to periprocedural management. To date, anesthetic personnel need to understand the pharmacodynamics and pharmacokinetics of the use of kratom and its chemical compounds.