Management périopératoire des patients alcoolo-dépendants

Every fifth patient undergoing surgical or diagnostic procedures has an alcohol use disorder (AUD). An early detection of these patients is important because of severe complications within the perioperative setting which include delirium, infections and severe sepsis/septic shock, coagulation disorders, arrhythmias, congestive heart failure, and impaired wound healing. By using evidence-based algorithms including adequate preoperative assessments with validated questionnaires and preventive measures aimed to reduce perioperative stress, a patient with an AUD has a much better outcome. For preoperative assessment, a validated questionnaire, such as the AUDIT, and short-term advice are required. Preoperative abstinence for only 4 weeks decreases complications by 50 %. Every second patient with an AUD is alcohol dependent. Alcohol dependent patients require treatment to counteract alcohol withdrawal syndrome. It is important to administer benzodiazepines, alpha-2 agonists, ketamine or haloperidol mainly in a preventive manner. The augmented stress response can be reduced by low-dose morphine or ethanol after surgery, for up to 3 days. Stress reduction decreases the risk of postoperative pneumonia. In surgical procedures or patients with high risk of hemorrhage, administration of positive inotropes is indicated due to possibly impaired cardiac function and the risk to develop cardiac failure in patients with AUD. Coagulation disorders (thrombocyte and plasmatic disorders) require an interventional protocol. Therefore, an approach based on validated scoring systems and evidence-based interventions reduce complications and duration of treatment. Early diagnosis allows preventive intervention. Preoperative abstinence is associated with a reduction of postoperative morbidity.