Perioperative management of patients with alcohol, tobacco and drug dependency.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Kork
Felix
F
Kliniken für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Neumann
Tim
T
Spies
Claudia
C
D000437:Alcoholism / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D013312:Stress, Physiological; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D014029:Tobacco Use Disorder / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D014899:Wernicke Encephalopathy / Q000209:etiology / Q000517:prevention & control