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Emergence of xylazine as a public health threat: what does the anesthesiologist need to know for perioperative care?
  1. Pawan K Solanki1,
  2. Samir Yellapragada1,
  3. Brendan Lynch1,
  4. Maria Eibel1,
  5. Eugene R Viscusi2 and
  6. Trent Emerick1
  1. 1Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, UPMC, Pittsburgh, Pennsylvania, USA
  2. 2Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Pawan K Solanki, Anesthesiology and Perioperative Medicine, UPMC, Kaufmann Building, 3471 Fifth Avenue Suite 402, Pittsburgh, PA 15213-2582, USA; solankipk3{at}


This paper explores the rapid emergence of xylazine exposure in the USA and its implications for anesthesiologists. Xylazine, a non-opioid sedative and analgesic often used in veterinary medicine, has increasingly been found as an adulterant in the illicit substance supply, leading to serious health implications. The pharmacological properties of xylazine, its clinical effects, and the challenges it poses for clinicans will be discussed. Perioperative strategies for anesthesiologists to manage these potential cases are provided. Furthermore, this paper necessitates an epidemiological understanding for detection and multidisciplinary collaboration in addressing this emerging public health threat. The manuscript concludes by emphasizing the role anesthesiologists will have to play in managing the clinical implications of xylazine and contributing to public health strategies aimed at curbing its misuse.

  • anesthesia, conduction
  • drug-related side effects and adverse reactions
  • outcome assessment, health care
  • patient education as topic
  • education

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  • Contributors PKS and TE contributed equally to this work and served as co-first authors. SY, BL, PKS, ME, and TE conducted a comprehensive literature review, outlined, and drafted the manuscript. TE proposed the novel idea for creation of an informant piece geared for the practicing anesthesiologist. ERV expertise on the topic was instrumental in providing a clinical focus. PKS, TE, SY, BL, ERV contributed to the editing and final approval of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests TE holds stock/equity at Vanish Therapeutics.

  • Provenance and peer review Not commissioned; externally peer reviewed.