Advertisement

Alcohol Withdrawal in the Surgical Patient: Prevention and Treatment

  • Anja Heymann
  • Irit Nachtigall
  • Anton Goldmann
  • Claudia Spies

Abstract

Alcohol withdrawal syndrome (AWS) is a common condition seen in hospital practice consisting of symptoms and signs that typically develop in alcohol-dependent patients 6–24 h after the last drink.

Keywords

Alcohol Dependence Alcohol Withdrawal Syndrome Delirium Tremens Chronic Alcohol Exposure Serum Electrolyte Concentration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Lieber CS. Medical disorders of alcoholism. N Engl J Med. 1995;333:1058–1065.PubMedCrossRefGoogle Scholar
  2. 2.
    Stanley KM, Worrall CL, Lunsford SL, Simpson KN, Miller JG, Spencer AP. Experience with adult alcohol withdrawal syndrome practice guideline in internal medicine patients. Pharmacotherapy. 2005;25(8):1073–1083.PubMedCrossRefGoogle Scholar
  3. 3.
    McKeon A, Frye MA, Delanty N. The alcohol withdrawal syndrome. J Neurol Neurosurg Psychiatry. 2008;79(8):854–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Moore RD, Bone LR, Geller G, Mamon JA, Stokes EJ, Levine DM. Prevalence, detection and treatment of alcoholism in hospitalized patients. JAMA. 1989;261:403–407.PubMedCrossRefGoogle Scholar
  5. 5.
    Smith-Warner SA, Spiegelman D, Yaun SS, et al. Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA. 1998;279(7):535–540.PubMedCrossRefGoogle Scholar
  6. 6.
    Seitz HK, Simanowski UA. Ethanol and carcinogenesis of the alimentary tract. Clin Exp Res. 1986;10(6 Suppl):33S–40S.CrossRefGoogle Scholar
  7. 7.
    Vokes EE, Weichselbaum RR, Lippman SM, Hong WK. Head and neck cancer. N Engl J Med. 1993;328(3):184–194.PubMedCrossRefGoogle Scholar
  8. 8.
    Spies C, Spies KP, Zinke S, et al. Alcoholism and carcinoma change the intracellular pH and activate the platelet Na+/H+- exchange in men. Alcohol Clin Exp Res. 1997;21:1653–1660.PubMedGoogle Scholar
  9. 9.
    Sander M, Neumann T, von Dossow V, et al. Alcohol use disorder: risks in anesthesia and intensive care medicine. Internist. 2006;47(4):332–341.PubMedCrossRefGoogle Scholar
  10. 10.
    Hervé C, Gaillard M, Roujas F, Huguenard P. Alcoholism in polytrauma. J Trauma. 1986;26:1123–1126.PubMedCrossRefGoogle Scholar
  11. 11.
    Spies C, Neuner B, Neumann T, et al. Intercurrent complications in chronic alcoholics admitted to the intensive care unit following trauma. Intensive Care Med. 1996;22:286–293.PubMedCrossRefGoogle Scholar
  12. 12.
    Spies C, Nordmann A, Brummer G, et al. Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract. Acta Anaesthesiol Scand. 1996;40:649–656.PubMedCrossRefGoogle Scholar
  13. 13.
    Spies CD, Rommelspacher H, Winkler T, et al. Beta-carbolines in chronic alcoholics following trauma. Addict Biol. 1996;1:93–103.PubMedCrossRefGoogle Scholar
  14. 14.
    Jensen NH, Dragsted L, Christensen JK, Jørgensen JC, Qvist J. Severity of illness and outcome in alcoholic patients in the intensive care unit. Intensive Care Med. 1988;15:19–22.PubMedCrossRefGoogle Scholar
  15. 15.
    Eggers V, Pascher A, Althoff H, et al. Immune reactivity is more suppressed in patients with alcoholic liver disease than in patients with virus-induced cirrhosis after CRH stimulation. Alcohol Clin Exp Res. 2006;30:140–149.PubMedCrossRefGoogle Scholar
  16. 16.
    Jurkovich G, Rivara FP, Gurney JG, et al. The effect of acute intoxication and chronic alcohol abuse on outcome from trauma. JAMA. 1993;270:51–56.PubMedCrossRefGoogle Scholar
  17. 17.
    Volk T, Dopfmer UR, Schmutzler M, et al. Stress induced IL-10 does not seem to be essential for early monocyte deactivation following cardiac surgery. Cytokine. 2003;24:237–243.PubMedCrossRefGoogle Scholar
  18. 18.
    Tønnesen H, Petersen K, Højgaard L, et al. Postoperative morbidity among symptom-free alcohol misusers. Lancet. 1992;340:334–337.PubMedCrossRefGoogle Scholar
  19. 19.
    Spies C, Tønnesen H, Andreasson S, Helander A, Conigrave K. Perioperative morbidity and mortality in chronic alcoholic patients. Alcohol Clin Exp Res. 2001;25(5 Suppl ISBRA):164S–170S.PubMedCrossRefGoogle Scholar
  20. 20.
    Spies CD, Dubisz N, Neumann T, et al. Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomized trial. Crit Care Med. 1996;24:414–422.PubMedCrossRefGoogle Scholar
  21. 21.
    Spies CD, Herpell J, Beck O, et al. The urinary ratio of 5-hydroxytryptophol to 5-hydroxyindole-3-acetic acid in surgical patients with chronic alcohol misuse. Alcohol. 1999;17:19–27.PubMedCrossRefGoogle Scholar
  22. 22.
    Spies CD, Nordmann A, Brummer G, et al. Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract. Acta Anaesthesiol Scand. 1996;40:649–656.PubMedCrossRefGoogle Scholar
  23. 23.
    American Psychiatric Association. DSM-IV options book. Washington, DC: American Psychiatric Association; 1991.Google Scholar
  24. 24.
    World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.Google Scholar
  25. 25.
    Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion a assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286:2703–2710.PubMedCrossRefGoogle Scholar
  26. 26.
    Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29:1370–1379.PubMedCrossRefGoogle Scholar
  27. 27.
    Otter H, Martin J, Basell K, et al. Validity and reliability of the DDS for severity of delirium in the ICU. Neurocrit Care. 2005;2:150–158.PubMedCrossRefGoogle Scholar
  28. 28.
    Jackson JC, Gordon SM, Hart RP, et al. The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychol Rev. 2004;14:87–98.PubMedCrossRefGoogle Scholar
  29. 29.
    Wacker P, Nunes PV, Cabrita H, et al. Post-operative delirium is associated with poor cognitive outcome and dementia. Dement Geriatr Cogn Disord. 2006;21:221–227.PubMedCrossRefGoogle Scholar
  30. 30.
    Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001;27:1892–1900.PubMedCrossRefGoogle Scholar
  31. 31.
    Thomason JW, Shintani A, Peterson JF, et al. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care. 2005;9:R375–R381.PubMedCrossRefGoogle Scholar
  32. 32.
    Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291:1753–1762.PubMedCrossRefGoogle Scholar
  33. 33.
    Milbrandt EB, Deppen S, Harrison PL, et al. Costs associated with delirium in mechanically ventilated patients. Crit Care Med. 2004;32:955–962.PubMedCrossRefGoogle Scholar
  34. 34.
    Spies C, Rommelspacher H, Schaffartzik W. Chronic alcoholics: high risk patients in intensive care units. In: Vincent JL, editor. Yearbook of intensive care medicine. Berlin: Springer; 1995. p. 777–788.CrossRefGoogle Scholar
  35. 35.
    Hoffman PL, Tabakoff B. Alcohol dependence: a commentary on mechanisms. Alcohol Alcohol. 1996;31:333–340.PubMedCrossRefGoogle Scholar
  36. 36.
    Dodd P. Neural mechanisms of adaptation in chronic ethanol exposure and alcoholism. Alcohol Clin Exp Res. 1996;20:151A–156A.PubMedCrossRefGoogle Scholar
  37. 37.
    Rommelspacher H, Schmidt LG, Helmchen H. Pathobiochemie und Pharmakotherapie des Alkoholentzugssyndroms. Nervenarzt. 1991;62:649–657.PubMedGoogle Scholar
  38. 38.
    Ortiz J, Fitzgerald LW, Charlton M, et al. Biochemical actions of chronic ethanol exposure in the mesolimbic dopamine system. Synapse. 1995;21:289–298.PubMedCrossRefGoogle Scholar
  39. 39.
    Möller HJ, Angermund MB. Prävalenzraten von Alcoholismus an einem chirurgischen Allgemeinkrankenhaus: empirische Untersuchungen mit dem Münchener-Alkoholismus-Test. Suchtgefahren. 1987;33:199–202.Google Scholar
  40. 40.
    Martin M, Heymann C, Neumann T, et al. Preoperative evaluation of chronic alcoholics assessed for surgery of the upper digestive tract. Alcohol Clin Exp Res. 2002;26:836–840.PubMedCrossRefGoogle Scholar
  41. 41.
    Tønnesen H, Rosenberg J, Nielsen HJ, et al. Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomized controlled trial. BMJ. 1999;318:1311–1316.PubMedCrossRefGoogle Scholar
  42. 42.
    Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252:1905–1907.PubMedCrossRefGoogle Scholar
  43. 43.
    Buchsbaum DG, Buchanan RG, Centor RM, et al. Screening for alcohol abuse using CAGE scores and likelihood ratios. Ann Intern Med. 1991;115:774–777.PubMedCrossRefGoogle Scholar
  44. 44.
    Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). J Addict. 1989;84:1353–1357.CrossRefGoogle Scholar
  45. 45.
    Mayo-Smith MF. Pharmacological management of alcohol withdrawal. JAMA. 1997;278:144–151.PubMedCrossRefGoogle Scholar
  46. 46.
    Imdahl H, Imdahl A. Prophylaxis and therapy of alcoholic delirium tremens in surgery: analysis of questionnaire inquiry. Aktuelle Chir. 1992;27:139–143.Google Scholar
  47. 47.
    Spies C, Dubisz N, Funk W, et al. Prophylaxis of alcohol withdrawal syndrome in alcohol dependent patients admitted to the intensive care unit following tumour resection. Br J Anaesth. 1995;75:734–739.PubMedCrossRefGoogle Scholar
  48. 48.
    Spies C, Eggers V, Szabo G, et al. Intervention at the level of the neuroendocrine- immune axis and postoperative pneumonia rate in long-term alcoholics. Am J Respir Crit Care. 2006;174:408–414.CrossRefGoogle Scholar
  49. 49.
    Weinberg JA, Magnotti LJ, Fischer PE. Comparison of intravenous ethanol versus diazepam for alcohol withdrawal prophylaxis in the trauma ICU: results of a randomized trial. J Trauma. 2008;64:99–104.PubMedCrossRefGoogle Scholar
  50. 50.
    The Plinius Major Society. Guidelines on evaluation of treatment of alcohol dependence. Alcoholism. 1994;30(Suppl):1–83.Google Scholar
  51. 51.
    Spies C, Otter H, Hüske B, et al. Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU. Intensive Care Med. 2003;29:2230–2238.PubMedCrossRefGoogle Scholar
  52. 52.
    Saitz R, Mayo-Smith MF, Roberts MS, et al. Individualized treatment for alcohol withdrawal: a randomized double-blind controlled trial. JAMA. 1994;272:519–523.PubMedCrossRefGoogle Scholar
  53. 53.
    Baumgartner GR, Rowen RC. Clonidine vs. chlordiazepoxide in the management of acute alcohol withdrawal syndrome. Arch Intern Med. 1987;147:1223–1226.PubMedCrossRefGoogle Scholar
  54. 54.
    Baumgartner GR. Transdermal clonidine versus chlordiazepoxide in alcohol withdrawal: a randomized, controlled clinical trial. South Med J. 1991;84:312–321.PubMedCrossRefGoogle Scholar
  55. 55.
    Darrouj J, Puri N, Prince E, et al. Dexmedetomidine infusion as adjunctive therapy to benzodiazepines for acute alcohol withdrawal. Ann Pharmacother. 2008;42(11):1703–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Ereshefsky L. Pharmacologic and pharmacokinetic considerations in choosing an antipsychotic. J Clin Psychiatry. 1999;60(Suppl 10):20–30.PubMedGoogle Scholar
  57. 57.
    Mirski MA, Muffelman B, Ulatowski JA, Hanley DF. Sedation for the critically ill neurologic patient. Crit Care Med. 1995;23:2038–2053.PubMedCrossRefGoogle Scholar
  58. 58.
    Coomes TR, Smith SW. Successful use of propofol in refractory delirium tremens. Emerg Med. 1997;30:825–828.Google Scholar
  59. 59.
    Hansbrough JF, Zapata-Sirvent RL, Carroll WJ, et al. Administration of intravenous alcohol for the prevention of withdrawal in alcoholic burn patients. Am J Surg. 1984;148:266–269.PubMedCrossRefGoogle Scholar
  60. 60.
    Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–617.PubMedCrossRefGoogle Scholar
  61. 61.
    Uchida I, Li L, Yang J. The role of the GABA(A) receptor alpha1 subunit N-terminal extracellular domain in propofol potentiation of chloride current. Neuropharmacology. 1997;36:1611–1621.PubMedCrossRefGoogle Scholar
  62. 62.
    Ermakov S, Crippen DW. Continuous propofol infusion for sedation in delirium tremens. Crit Care Med. 1994;20(Suppl):S37.Google Scholar
  63. 63.
    Hall W, Zador D. The alcohol withdrawal syndrome. Lancet. 1997;349:1897–1900.PubMedCrossRefGoogle Scholar
  64. 64.
    Hara M, Kai Y, Ikemoto Y. Propofol activates GABA-A receptor-chloride ionophore complex in dissociated hippocampal pyramidal neurons of the rat. Anesthesiology. 1993;79:781–788.PubMedCrossRefGoogle Scholar
  65. 65.
    McCowan C, Marik P. Refractory delirium tremens treated with propofol. A case series. Crit Care Med. 2000;28:1781–1784.PubMedCrossRefGoogle Scholar
  66. 66.
    Orser BA, Bertlik M, Wang LY, et al. Inhibition by propofol (2, 6 di-isopropylphenol) of the N-methyl D-aspartate subtype of glutamate receptor in cultured hippocampal neurones. Br J Pharmacol. 1995;116:1761–1768.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Anja Heymann
    • 1
  • Irit Nachtigall
    • 2
  • Anton Goldmann
    • 3
  • Claudia Spies
    • 4
  1. 1.Resident, Department of AnesthesiologyCharité – Universitätsmedizin BerlinBerlinGermany
  2. 2.Department of AnesthesiologyCharité – Universitätsmedizin BerlinBerlinGermany
  3. 3.Department of Anesthesiology and Intensive Care MedicineCharité – Universitätsmedizin BerlinBerlinGermany
  4. 4.Professor, Department of Anesthesiology and Intensive Care MedicineCharité – Universitätsmedizin BerlinBerlinGermany

Personalised recommendations