Narrative review of psilocybin, an important psychoactive substance with potential peri-anesthetic implications

Abstract

Psilocybin is a psychedelic substance with history of use for religious, medicinal and hallucinogenic purposes. The purpose of this review is to assess its past use, and its role both broadly in medicine and specifically in anesthesiology. Studies have shown benefits for chronic pain management, demonstrating utility in conditions including headaches and fibromyalgia, and psychiatric disturbances such as depression and anxiety. It has a high safety prof0ile, with a large disparity between a physiologic dose and that required to cause overdose symptoms. Its structure allows it to function as a serotonin receptor agonist, affecting the wiring of the brain and leading to possible anti-inflammatory effects. Perioperative management by anesthesia professionals should include a thorough pre-anesthetic exam to assess for usage and associated symptoms, as well as targeted testing. Intoxication requires supportive care, while overdose and withdrawal symptoms may require management of one's airway, circulation or appropriate medication. Patients should be monitored through the perioperative period, for psychologic symptoms that may necessitate modifications to the physical environment or pharmaceutical interventions. Rates of usage of psilocybin may increase if removed from Schedule I by the FDA based upon therapeutic uses for chronic pain and psychological disorders, amongst other conditions.