Perioperative management of patients with alcohol, tobacco and drug dependency

Abstract

Alcohol, nicotine and drug dependency are very treatable. Numerous effective therapeutic options are available and should be offered to patients. Intensive care treatment can be shortened or even avoided by initiating preventive measures. A multimodal approach includes implementation of screening tools, motivational interviewing, preoperative abstinence, individual anaesthesiological treatment, stress reduction preventing delirium and postoperative infection, prevention and treatment of withdrawal syndrome, replacement therapies and provision of preoperative or postoperative detoxification. The implementation rate is very low and urgently requires strategies for improvement.

Prevention and Therapy of Alcohol Withdrawal on Intensive Care Units: Systematic Review of Controlled Trials

“…Numerous previous publications see i.v. EtOH as an acceptable agent for AWS prophylaxis (Engelhardt, ; Kork et al., ; Sander et al., ; Spies and Rommelspacher, ; Vagts and Nöldge‐Schomburg, ). More powerful multicenter trials are required to answer the question if any of the above‐discussed agents or combinations is superior to the others.…”

“…There are many other potential substances or methods to prevent AWS: some authors stress the importance of detecting patients at risk by screening tools as well as general measures like nutrition, volume resuscitation, and preoperative abstinence (Kork et al., ; Sarff and Gold, ). Two general review articles conclude that GHB can also be effective to prevent AWS in ICUs (Kleinschmidt and Mertzlufft, ; Meyer et al., ), but there are no published controlled trials that investigated GHB for AWS prevention.…”

Alcohol, Nicotine, and Iatrogenic Withdrawals in the ICU

“…Biomarkers, such as serum, saliva, and urinary cotinine levels, a metabolite of nicotine, can be used to discriminate smokers from nonsmokers (106,107). Acute smoking can also be assessed with carbon monoxide-hemoglobin and exhaled carbon monoxide (108)(109)(110). The Fagerström Test of Nicotine dependence allows the evaluation of degrees of tobacco dependency (111).…”

Perioperative Management of Alcohol Withdrawal Syndrome

“…Due to the high morbidity and mortality of AWS, screening and prophylaxis in the perioperative setting are mandatory [2]: among individuals with a history of longterm heavy alcohol drinking, 50% might develop AWS [30]; 90% of these cases are mild and easily managed by symptomatic treatment while the remaining 10% of the symptomatic patients develop generalized tonic-clonic seizures or delirium tremens [19]. Especially for severely alcohol-dependent subjects, it is ethically required to provide prophylactic AWS medication during the perioperative period as shown in a systematic review [15]: before the onset of AWS symptoms, BZO as well as continued oral or enterally applied alcohol administration in a dose Visc Med 2020;36:160-166 DOI: 10.1159/000507595 of 0.5 g/kg body weight/day are proven to be safe and effective in preventing severe withdrawal [31].…”

“…Especially in post-traumatic emergency surgery and in patients with aero-digestive oncology surgery, AUD are seen in 50% of the patients. Half of these, meaning approximately 25% of all patients in these surgical groups, have alcohol dependency [2]. The reported prevalence varies depending on the surgical specialty and the used screening methods.…”