Alcohol withdrawal in the surgical patient: prevention and treatment

Anesth Analg. 1999 Apr;88(4):946-54. doi: 10.1097/00000539-199904000-00050.

Abstract

In the literature on AWS, there is repeated emphasis on performing a thorough preanesthesia assessment in patients with suspected chronic alcohol use. Because these patients are difficult to diagnose and to treat in surgical settings if complications arise, a multimodal approach is highly recommended (86). Ideally, AWS should be prevented by adequate prophylaxis. If AWS develops after surgery or trauma, immediate therapy is required. The symptoms of AWS can be controlled using the combination of a benzodiazepine (in Europe, also chlormethiazole) with haloperidol or clonidine. The drug regimens must be individualized and symptom-oriented to treat hallucinations and autonomic signs. Dosages are generally larger than those in detoxification units. Other approaches to modulate the neuroendocrine-immune axis in patients with an increased risk of postoperative infectious complications look promising but await controlled trials.

Publication types

  • Review

MeSH terms

  • Alcohol-Related Disorders / physiopathology
  • Alcohol-Related Disorders / prevention & control*
  • Alcohol-Related Disorders / therapy
  • Animals
  • Critical Care
  • Diagnosis, Differential
  • Female
  • Guidelines as Topic
  • Humans
  • Male
  • Perioperative Care
  • Postoperative Complications / prevention & control*
  • Postoperative Complications / therapy*
  • Substance Withdrawal Syndrome / physiopathology
  • Substance Withdrawal Syndrome / prevention & control*
  • Substance Withdrawal Syndrome / therapy*
  • Surgical Procedures, Operative*