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Perioperative management of patients with alcohol, tobacco and drug dependency

Kork, Felix; Neumann, Tim; Spies, Claudia

Current Opinion in Anaesthesiology: June 2010 - Volume 23 - Issue 3 - p 384–390
doi: 10.1097/ACO.0b013e3283391f79
Anaesthesia and medical disease: Edited by Lee Fleisher and Benjamin Kohl

Purpose of review One in five patients in the perioperative setting has a alcohol use disorder (AUD), one in three patients has a nicotine use disorder (NUD) and one in 10 patients has a drug use disorder (DUD) with a high risk of dependency. Patients with dependencies challenge physicians with various complications within the perioperative setting.

Recent findings Adequate treatment of alcohol, nicotine and drug dependency during the perioperative and intraoperative course requires established screening tools in order to evaluate patients' susceptibility to developing complications. Particularly in these patients, secondary prevention and early treatment is warranted.

Summary 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.

Kliniken für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany

Correspondence to Claudia Spies, MD, Professor of Anesthesiology and Intensive Care Medicine, Head of Department of Anesthesiology and Intensive Care Medicine, Charité – Campus Virchow Klinikum und Charité Campus Mitte, Augustenburger Platz 1, 13353 Berlin, Germany Tel: +49 30 450 551002; fax: +49 30 450 551019; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.