1768: A CASE OF ACUTE SPINAL EPIDURAL HEMATOMA ON RIVAROXABAN THERAPY AFTER FALL INJURY

Abstract

Learning Objectives: Methamphetamine use is on the rise. As a non-catecholamine, sympathetic amine, methamphetamine increases norepinephrine, serotonin and dopamine and has been associated with cardiac dysrhythmias. Chronic use of meth can lead to a relative deficiency of these neurotransmitters and in the presence of general anesthesia lead to hypotension requiring treatment. Our aim was to describe the outcomes of patients undergoing operation for trauma with a positive urine drug screen for methamphetamine. Methods: This is a retrospective cohort review of injured patients at our institution. Patients were identified from the Trauma Registry and included if they had a positive urine drug screen for methamphetamine and underwent operation in the first 24 hours of admission. Descriptive statistics were utilized as there were no comparison groups. Results: 92 patients were identified with positive urine drug screens for methamphetamine who also went to the operating room within 24 hours of admission. The majority of these patients were white (97.8%), young (median age 32 +/19) and male (77%). The mechanism of injury was blunt for 60% of the patients. The median ISS was 14 (+/12) and there were 2 mortalities in the cohort. The majority of patients had no known comorbidities (n=31), hypertension was the most common noted comorbidity (n=30) and 9 patients were known Hepatitis C positive on arrival. Polysubstance use was frequent with 85% of patients identified having another substance positive on urine drug screening. Opioids were the most frequently identified concurrent substance (57%), followed by marijuana (50%), benzodiazepines (40%), buprenorphine (15%) and cocaine (11%). 31 (33%) of the patients were intubated prior to the OR and 60 (65%) were operated on emergently. Of emergent procedures, the operating service was most commonly Trauma Surgery (81.7%) followed by Neurosurgery (3.3%), Vascular Surgery, and ENT. None of the patients developed arrhythmias during operation. The majority of the patients did not require intermittent vasopressor doses during the operation (65.2%). Only 15 patients received multiple doses of vasopressor (16.3%). No intraoperative deaths occurred Conclusions: Among a retrospective cohort of injured patients operated on emergently, there were no intraoperative deaths or cardiac dysrhythmias in the setting of methamphetamine use. This cohort was underpowered to comment on safety but adds to the literature by addressing intraoperative outcomes in this population.