title: Preoperative Evaluation of the Patient with Substance Use Disorder and Perioperative Considerations.
abstract: The patient with a current or former history of substance use disorder can be challenging to adequately care for in the perioperative period. A thorough preoperative evaluation is essential. In addition to drug abuse screening, the evaluation should include an assessment of the effects of the substance abuse, associated diseases, end-organ damage, and an awareness of the potential perioperative risks so appropriate plans are developed to minimize the risks. Intraoperatively, anesthetic management needs to be appropriately modified. Signs and symptoms of withdrawal should be monitored for postoperatively. Pain management is particularly challenging. After discharge, this patient population is vulnerable and requires close follow-up and early referral to appropriate specialists when needed.
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Campus Box 8054, St Louis, MO 63110, USA. Electronic address: pulleyd@wustl.edu.
authors.forename: Debra Domino
authors.initials: DD
authors.lastname: Pulley
mesh_terms: D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D018570:Risk Assessment; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*
keywords: Addiction; Alcoholism; Chronic opioid use; Cocaine; Preoperative drug testing; Preoperative evaluation; Substance use disorder