Phencyclidine (PCP) and elective surgeries

[sigrhoillusion]

Thoughts?
Go ahead? Postpone?
Are you ok with any drugs outside of prescribed pain meds and methadone for elective cases?

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[linkin06]

If truly elective, then I would question them being able to consent for the surgery. If emergency, then proceed. I'm imagining PCP can make you quite altered, almost to a psychotic state. Perhaps it would be similar to ketamine in its hemodynamic effects? Lots of versed, etomidate vs propofol to go to sleep. I don't think I would extubate without knowing mental status is normal.

 

[deleted162650]

Are you ok with any drugs outside of prescribed pain meds and methadone for elective cases?

Generally I try not to have any before elective cases.

 

[pgg]

Acute intoxication of anything is always a hard stop for elective surgery.

The gray area in my mind is the positive tox screen for _____ in a patient who is not presently intoxicated, presenting for elective surgery. For those cases, I’ll proceed unless it’s cocaine or meth. Reasonable people can disagree that I’m either too conservative or too cowboyish but that’s where my line is.

My concerns with a PCP user are
- acute intoxication (consent)
- proven bad judgment and likelihood that the patient will be noncompliant with treatment / postop instructions resulting in an avoidable poor outcome
- not so much the physiologic issues

 

[sigrhoillusion]

Generally I try not to have any before elective cases.[/QUOTE

Guy didn't appear altered but just shady when confronted about the +UDS. The UDS was from pre-op office a few days before and not ordered by me and not sure why it was originally ordered.

I work in a very urban facility and I bet a good % of patients are on something and I rarely test unless super suspicious.

Question is more related to incidences where you're presented with the info and what you usually do.

I ordered a repeat and told or and surgeon if +ve would postpone as elective case and healthy patient not worth risk of dysrhythmia.

Thoughts?

 

[sigrhoillusion]

Acute intoxication of anything is always a hard stop for elective surgery.

The gray area in my mind is the positive tox screen for _____ in a patient who is not presently intoxicated, presenting for elective surgery. For those cases, I’ll proceed unless it’s cocaine or meth. Reasonable people can disagree that I’m either too conservative or too cowboyish but that’s where my line is.

My concerns with a PCP user are
- acute intoxication (consent)
- proven bad judgment and likelihood that the patient will be noncompliant with treatment / postop instructions resulting in an avoidable poor outcome
- not so much the physiologic issues

That's usually my approach. I always repeat day of to ensure it's negative or nothing new is present. I was more conservative cause I knew colleague was going to be taking room and didn't want something to happen and have blame go around.

 

[deleted59964]

add 200mg ketamine and you're good to go ...