Central nervous system stimulants: basic pharmacology and relevance to anaesthesia

Convulsants and respiratory stimulant drugs increase reflex excitability but have little effect on mental function. Although many have been used as respiratory stimulants in the past, only doxapram has a sufficiently wide margin of safety to be used for this purpose in modern medicine. The psychomotor stimulants that produce excitement, locomotor stimulation and euphoria are rarely used clinically for this purpose, but they can cause unpredictable hypotension and modified responses to other drugs if they are being misused by a patient who then presents for anaesthesia and surgery. Methylphenidate and dexamphetamine can be useful in the treatment of attention deficit hyperactivity disorder, and dexamphetamine and modafinil can be useful in narcolepsy. Cocaine is still used as a local anaesthetic in ear, nose