Central nervous system stimulants: basic pharmacology and relevance to anaesthesia and critical care

Central nervous system (CNS) stimulants are common in clinical practice, and have a high potential for abuse. The CNS stimulants can be classified as analeptic stimulants, psychomotor stimulants, or methylxanthines. Doxapram activates peripheral chemoreceptors and central respiratory centres in a dose-dependent manner. Psychomotor stimulants (e.g. cocaine and amfetamines) increase sympathetic nervous system activity. Competition for various metabolic and transport processes can lead to dangerous drug interactions. Sympathomimesis in the perioperative period may result in haemodynamic instability, cardiac dysrhythmias, and myocardial ischaemia. Therapeutic methylxanthines are used mainly to stimulate respiratory centres.