Perioperative management

Abstract

Surgery may be required for complications of alcohol use such as the management of traumatic injuries and cancers. Patients with unhealthy alcohol use will also be among those who are planning to undergo surgery for conditions that are unrelated to alcohol use. Alcohol use disorders (AUDs), alcohol-associated chronic medical conditions, and even heavy drinking without an AUD can increase the risk of postoperative complications. Hospitalization for surgery may be the first time that an alcohol dependent patient does not have access to alcohol, putting them at risk for withdrawal. Acute withdrawal syndromes may complicate surgery and the postoperative course with tachycardia, hypertension, anxiety, delirium, pain, and seizures. Therefore, providers of perioperative care must identify unhealthy alcohol use and be comfortable with the management of withdrawal syndromes. Careful evaluation may detect clinical signs of chronic diseases secondary to alcohol use that increase surgical risk, such as diseases affecting the cardiovascular system, liver, bone marrow, nervous system and pancreas. In addition, the physiological stress associated with surgery may bring out sub-clinical co-morbidities not obvious during routine preoperative evaluation. This chapter focuses on relevant perioperative issues in the patient with unhealthy alcohol use.