If you take prescribed ADHD stimulant medicine, it is often continued through surgery because few problems are seen and it can help avoid withdrawal and keep you steady during the perioperative period. Tapering is sometimes possible, but continuation is the preferred path in the source material for chronic prescription use. For people who misuse stimulants or have acute intoxication, the plan is different: elective surgery should be postponed if there is acute intoxication, and care should be guided by the surgical and anesthesia team with SUD expert input. Verify the exact plan with your surgical or anesthesia team in case they want something different for you.

Anesthesia can also work a little differently. Chronic stimulant use may lower the amount of anesthesia needed or have little effect, while acute intoxication may raise it. If blood pressure drops, direct-acting vasopressors are preferred, such as phenylephrine, epinephrine, or norepinephrine, because ephedrine may not work well.

Other useful points: beta-blockers are generally avoided in acute stimulant intoxication, and medicines like benzodiazepines and alpha-2 agonists are often useful for calming agitation and lowering heart rate and blood pressure.