Preoperative assessment of carbohydrate-deficient transferrin (CDT) in surgical patients and a prevention of abstinence syndrome
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KeywordsLiver Disease Transferrin Clonidine Elective Operation Liver Dysfunction
Complications are much more frequent in chronic alcoholics than in the remaining population after an elective operation or in some other case, like trauma or acute abdomen. In the postoperative period, alcoholics, suffering frequently from a liver disease, malnutrition etc., are threatened with infection, vegetative and metabolic dysregulation, heard ischemia, liver dysfunction and also with a rise of acute abstinence syndrome.
Treatment of the syndrome is mostly based on sedation of the patient to suppress anxiety, agitation or aggressiveness and also to control vegetative manifestations. The drugs, which are mostly used, are able to sedate the patient, on the other hand they make the postoperative care difficult and increase the complication rate. Therefore, improvement of the results demands first of all to identify all risky patients (including secret alcoholics) and to find a suitable medication to suppress the abstinence with minimal sedation of the patient.
It has been known since 1976 that pathological carbohydrate-deficient fraction of transferrin (CDT) occurs in blood plasma of people who are used to consuming more than 60 g of alcohol daily during 14 days, and disappears again after abstinence. The authors have used detection of CDT according to Boehringer–Mann in their hospital since 1998. The results are very precise and reliable.
The test was performed in 228 surgical patients till 30 April 2001, it was positive in 146 patients. In prevention of the abstinence syndrome, the authors obtained the best results by administering clonidine. It reduces the sympathetic reaction to abstinence and surgery. The drug was used in 42 patients with proven preoperative elevation of CDT in dosage 2 × 0.150 mg i.v. Neither abstinence syndrome nor side effects were observed.
The authors suppose the described management, i.e. detection of chronic alcoholics and prevention of the abstinence syndrome in them, to be the most reliable and very effective method.