title: "Robo-tripping": dextromethorphan abuse and its anesthetic implications.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors: Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.
authors: Kelly A
authors: KA
authors: Linn
authors: Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.
authors: Micah T
authors: MT
authors: Long
authors: Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.
authors: Paul S
authors: PS
authors: Pagel
keywords: Addiction; Dextromethorphan; Dissociative Anesthesia; NMDA Receptor Antagonists; Sigma Opioid Receptor; Substance Abuse