ANESTHESIA AND THE DRUG-ABUSING PARTURIENT

Abstract

DRUGABUSEANDTHEPARTURIENT The drug-abusing parturient presents many challenges to the anesthesiologist. The unusual and clinically challenging situations that may arise in this patient population may be due to many factors including failure on the part of many of these patients to receive medical treatment during pregnancy, the effects of illicit drug use, unstable home environment, poor diet, and the presence of untreated co-existing disease. The absence of prenatal care has been shown to be a major factor in the outcome of these patients.I5 Substance abuse in pregnancy has emerged as a major public health problem of the 1990~~ Because of this, obstetricians, pediatricians, and anesthesiologists are now encountering an increasing number of pregnant patients who use illicit substances. In particular, cocaine use during pregnancy in the United States has increased dramatically during the past decade.76 Although it has been suggested that substance abuse may be on the decline in the United States, illicit substance abuse among women of childbearing age continues to be a major problem. Reports on the growing numbers of pregnant patients who are using illicit drugs has increased throughout the world. Chasnoff et a1 reported that almost 15% of pregnant women in one patient population in the United States had a positive urine toxicology screen for cocaine, marijuana, alcohol, or heroin.I4 Multiple drug use is not un~ommon.~ A recent study which examined the drug use patterns of pregnant women in two inner city sites found that women who used cocaine were much more likely to have used a combination of drugs? Recent data suggest that consumption of illicit drug use is also a problem in Europe, with reports from Italy’6, %; Spain56; Amsterdam-; and Eastem Europe.” The use of illicit drugs in pregnant patients can present very difficult challenges to the anesthesiologist. For example, the management of a