Adderall and General Anesthesia: Perioperative Management
Adderall does not need to be stopped before general anesthesia and can be safely continued perioperatively, based on multiple case series demonstrating cardiovascular stability and safe outcomes in patients on chronic amphetamine therapy. 1, 2
Key Perioperative Considerations
Cardiovascular Effects and Monitoring
Amphetamines stimulate norepinephrine release, causing α-adrenergic vasoconstriction (increased peripheral resistance) and β-adrenergic effects (increased heart rate, stroke volume, and skeletal muscle blood flow). 3
Patients on chronic amphetamine therapy maintain cardiovascular stability during general anesthesia, with case series of 8-9 patients (ages 22-77 years, anesthesia times 30 minutes to 4.25 hours) showing no intraoperative complications despite concerns about catecholamine depletion. 1, 2
The theoretical risk of catecholamine depletion leading to blunted response to intraoperative hypotension has not materialized in clinical practice. 1
Serotonin Syndrome Risk
Amphetamines increase the risk of serotonin syndrome when combined with serotonergic opioids (fentanyl, meperidine, methadone, tramadol, tapentadol) or other serotonergic agents. 4
This potentially fatal complication presents with neuroexcitatory symptoms, autonomic dysfunction, and neuromuscular abnormalities—monitor closely when using these opioid combinations. 4
Anesthetic Drug Interactions
Amphetamines may theoretically counteract sedatives and anesthetics, though clinical significance appears minimal in reported cases. 5
Balanced anesthesia techniques using multiple drug classes (for unconsciousness, analgesia, muscle relaxation, and homeostasis) are commonly employed and generally safe. 6
Clinical Management Strategy
Continue Adderall on the day of surgery rather than withholding it, as this approach has proven safe in multiple case reports spanning 2-40 years of chronic amphetamine use. 1, 5, 2
For patients taking Adderall for 2-10 years who underwent general anesthesia with tracheal intubation (6 of 8 patients), no cardiovascular instability or adverse outcomes occurred. 1
Both strategies (continuing versus withholding) have been reported, but the evidence favors continuation to avoid potential withdrawal effects and maintain baseline cardiovascular stability. 5
Specific Anesthetic Precautions
Avoid or use extreme caution with serotonergic opioids (fentanyl, meperidine, methadone, tramadol, tapentadol) due to serotonin syndrome risk. 4
Consider non-serotonergic opioids (morphine, hydromorphone) or regional anesthesia techniques when feasible to minimize drug interactions. 4
Monitor for tachycardia, hypertension, hyperthermia, and tremors—signs that may indicate excessive sympathetic stimulation or, in overdose scenarios, toxicity. 3
Common Pitfalls to Avoid
Do not routinely discontinue amphetamines preoperatively based on outdated concerns about catecholamine depletion—this theoretical risk is not supported by clinical evidence. 1, 2
Do not combine amphetamines with multiple serotonergic agents without heightened vigilance for serotonin syndrome, which can be fatal. 4
Be aware that both immediate-release and sustained-release formulations exist; knowing which formulation helps predict duration of clinical effects. 3