A 20-year-old man has been taking different kinds of anabolic steroids in cycles of 10-12 weeks for

Fråga: A 20-year-old man has been taking different kinds of anabolic steroids in cycles of 10-12 weeks for one year. Unspecified surgery on the foot in general anaesthesia is planned. What is known about anaesthesia in abusers of anabolic steroids?

Sammanfattning: The abuse of anabolic steroids is wide spread and lead to many adverse effects with possible implications in general anaesthesia. First of all, abuse of anabolic steroids must be suspected and investigated in the patient. There is a risk that the possibility of multiple drug use and organ deficiencies is not considered in a well trained, healthy looking young man or woman. Second, a more thorough preanaesthetic evaluation of the patient has to be performed including: complete haematological testing, electrolytes, liver function tests, electrocardiogram and chest X-ray.

Svar: A Medline-search has revealed one case report and two survey articles on the subject of anaesthesia and anabolic steroids (AS) all of which were published in 1991 (1-3).

Anabolic steroids, as misused by athletes and others, have a number of possible adverse effects upon the cardiovascular, endocrine and genital-urinary systems as well as the hepatic function and mental health of the abuser. This has previously been discussed on Drugline (4-7). These possible adverse effects should be considered in the preoperative evaluation of the patient.

Pharmacokinetics may be influenced by altered liver function or altered volume of distribution. Drug metabolism may be increased due to liver enzyme induction (liver values are often increased eventhough this has not been shown to be associated with decreased liver function) (6,8). Water retention from AS and the relatively low proportion of body fat in the athlete or body builder may result in increased volume of distribution and thus increase dosage requirements of for example muscle relaxants (3). Requirements of intravenous anaesthetics may also be increased; hence, special attention should be paid in order to avoid awareness during anaesthesia (9). The risk of both haemorrhage and thrombosis may be increased because of rich vascularisation of the muscles and a varying degree of polycythemia caused by stimulated erythropoiesis (and possibly aggravated by the use of diuretics). Other mechanisms (eg thrombocyte function) may also be involved, but have not been determined. Higher frequency of nose bleeding and haematospermia occurs in abusers of AS, and cases of thrombosis have been reported. When indicated, prophylaxis against thrombosis should not be forgotten in these patients (7).

The AS abuser´s heart may be affected in many ways. Thickening of the left ventricular wall, cardiomyopathy, arrythmia, accelerated coronary artery disease and myocardial infarction have been described in connection with high intake of AS, even though the frequencies of these possible adverse effects are unknown (4,5).

The possibility of multiple abuse (diuretics, NSAID´s, human chorionic gonadotropic hormone, amphetamine, cocaine etc) should also be considered.

There are no reported contraindications for local, spinal or epidural anaesthesia in abusers of AS (3).

In planned surgery, the patient should always be advised to stop the use of AS, preferably permanently, at least two weeks before surgery.