Advertisement

Anästhesie bei Patienten mit Suchterkrankungen

  • Tim Neumann
  • Claudia Spies
Living reference work entry
Part of the Springer Reference Medizin book series (SRM)

Zusammenfassung

Im operativ-chirurgischen Bereich besteht eine hohe Prävalenz von Suchterkrankungen. Substanzmissbrauch ist mit einer erhöhten Morbidität assoziiert. Dies bedingt einen häufigen Kontakt des klinisch tätigen Anästhesisten mit suchtkranken Patienten. Beim suchtkranken Patienten ist ein gezieltes diagnostisches Vorgehen erforderlich, da die Suchtdiagnose oft entweder erst anhand von Komplikationen im Verlauf gestellt wird oder die Intoxikation eine schwerwiegende Erkrankung verschleiert (z. B. Schädel-Hirn-Trauma und Alkoholintoxikation, Delir und Thiaminmangel, myokardiale Ischämie und Kokainabusus, Schmerzsyndrome und Opiatabusus). Viele Patienten nehmen mehr als eine Substanz ein (u. a. als Selbstmedikation bei Entzug oder psychiatrischen Erkrankungen). Die wichtigsten Aspekte werden in diesem Kapitel dargestellt.

Literatur

  1. 1.
    AWMF S3 – Leitlinie AWMF Leitlinien-Registernummer 076-001: Screening, Diagnose und Behandlung alkoholbezogener Störungen (Im Druck 2015). www.AWMF.org
  2. 2.
    AWMF S3 – Leitlinie AWMF Leitlinien-Registernummer 076-006: Interdisziplinäre Leitlinie der Qualität S3 zum Screening, der Diagnostik und Behandlung des schädlichen und abhängigen Tabakkonsums (Im Druck 2015). www.AWMF.org
  3. 3.
    Awissi DK, Lebrun G, Fagnan M, Skrobik Y, Regroupement de Soins Critiques, Réseau de Soins Respiratoires, Québec (2013) Alcohol, nicotine, and iatrogenic withdrawals in the ICU. Crit Care Med 41(9 Suppl 1):S57–S68, ReviewCrossRefPubMedGoogle Scholar
  4. 4.
    Bell J, Reed K, Gross S, Mr John Witton J (2013) The management of pain in people with a past or current history of addiction. www.actiononaddiction.org.uk
  5. 5.
    Courtney KE, Ray LA (2014) Methamphetamine: an update on epidemiology, pharmacology, clinical phenomenology, and treatment literature. Drug Alcohol Depend 143:11–21CrossRefPubMedGoogle Scholar
  6. 6.
  7. 7.
    Egred M, Davis GK (2005) Cocaine and the heart. Postgrad Med J 81:568–571CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sander M, Neumann T, von Dossow V et al (2006) Alkoholabusus: Risikofaktoren für die Anästhesie und Intensivmedizin (Alcohol use disorder: risks in anesthesia and intensive care medicine). Internist 47:332–341CrossRefPubMedGoogle Scholar
  9. 9.
    Spies CD, Rommelspacher H (1999) Alcohol withdrawal in the surgical patient: prevention and treatment. Anesth Analg 88:946–952CrossRefPubMedGoogle Scholar
  10. 10.
    Thomson AD, Guerrini I, Marshall EJ (2012) The evolution and treatment of Korsakoff’s syndrome: out of sight, out of mind? Neuropsychol Rev 22(2):81–92. https://doi.org/10.1007/s11065-012-9196-z, Epub 2012 May 9 ReviewCrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kip M, Neumann T, Jugel C et al (2008) New strategies to detect alcohol use disorder in the preoperative assessment clinic of a German university hospital. Anesthesiology 109:169–170CrossRefGoogle Scholar
  12. 12.
    Galvin R, Bråthen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA, EFNS (2010) FNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 2010(17):1408–1418CrossRefGoogle Scholar
  13. 13.
    Lieber CS (1995) Medical disorders of alcoholism. N Engl J Med 333:1058–1065CrossRefPubMedGoogle Scholar
  14. 14.
    Neumann T, Kox WJ, Spies CD (2003) Anästhesiologisches Vorgehen bei Sucht- und Begleiterkrankungen in Forschung und Praxis. Suchtmed 5:13–20Google Scholar
  15. 15.
    Neumann T, Spies C (2003) Use of biochemical markers in clinical practice. Addiction 98(Suppl 2):81–91CrossRefPubMedGoogle Scholar
  16. 16.
    Spies CD, Nordmann A, Brummer G et al (1996) Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract. Acta Anaesthesiol Scand 40:649–656CrossRefPubMedGoogle Scholar
  17. 17.
    Tønnesen H, Kehlet H (1999) Preoperative alcoholism and postoperative morbidity. Br J Surg 86:869–874CrossRefPubMedGoogle Scholar
  18. 18.
    Neumann T, Neuner B, Weiss-Gerlach E et al (2006) The effect of computerized tailored brief advice on at-risk drinking in subcritically injured trauma patients. J Trauma 61:805–814 #22CrossRefPubMedGoogle Scholar
  19. 19.
    Klotz U, Ammon E (1998) Clinical and toxicological consequences of the inductive potential of ethanol. Eur J Clin Pharmacol 54:7–12CrossRefPubMedGoogle Scholar
  20. 20.
    Riordan SM, Williams R (2002) Alcohol exposure and paracetamol-induced hepatotoxicity. Addict Biol 7:191–206CrossRefPubMedGoogle Scholar
  21. 21.
    Nuscheler M, Conzen P, Peter K (1989) Sevofluran. Metabolismus und Toxizität. Anästhesist 47:S24–S32CrossRefGoogle Scholar
  22. 22.
    Kork F, Neumann T, Spies C (2010) Perioperative management of patients with alcohol, tobacco and drug dependency. Curr Opin Anaesthesiol 23(3):384–390CrossRefPubMedGoogle Scholar
  23. 23.
    Tønnesen H, Nielsen PR, Lauritzen JB et al (2009) Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anesth 102:297–306CrossRefGoogle Scholar
  24. 24.
    Trzepacz PT, Brenner RP, Coffman GC et al (1988) Delirium in liver-transplantation candidates: discriminant analysis of multiple test variables. Biol Psychiatry 24:3–15CrossRefPubMedGoogle Scholar
  25. 25.
    Neumann T, Neuner B, Gentilello LM et al (2004) Gender differences in the performance of a computerized version of the alcohol use disorders identification test in subcritically injured patients who are admitted to the emergency department. Alcohol Clin Exp Res 28:1693–16701CrossRefPubMedGoogle Scholar
  26. 26.
    Rumpf HJ, Meyer C, Hapke U, John U (2003) Deutsche Version des Alcohol Use Disorders Identification Test (AUDIT-G-L). In: Glöckner-Rist A, Rist F, Küfner H (Hrsg) Elektronisches Handbuch zu Erhebungsinstrumenten im Suchtbereich (EHES). Version 3.00. Zentrum für Umfragen, Methoden und Analysen, MannheimGoogle Scholar
  27. 27.
    Martin MJ, Heymann C, Neumann T et al (2002) Preoperative evaluation of chronic alcoholics assessed for surgery of the upper digestive tract. Alcohol Clin Exp Res 26:836–840CrossRefPubMedGoogle Scholar
  28. 28.
    Tønnesen H, Rosenberg J, Nielsen HJ et al (1999) Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial. BMJ 318:1311–1316CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Spies C, Eggers V, Szabo G et al (2006) Intervention at the level of the neuroendocrine-immune axis and postoperative pneumonia rate in long-term alcoholics. Am J Respir Crit Care Med 174:408–414CrossRefPubMedGoogle Scholar
  30. 30.
    Ungur LA, Neuner B, John S, Wernecke K, Spies C (2013) Prevention and therapy of alcohol withdrawal on intensive care units: systematic review of controlled trials. Alcohol Clin Exp Res 37:675–686CrossRefPubMedGoogle Scholar
  31. 31.
    Lingford-Hughes AR, Welch S, Peters L, Nutt DJ, British Association for Psychopharmacology, Expert Reviewers Group (2012) BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol 26:899–952CrossRefPubMedGoogle Scholar
  32. 32.
    Garfield JM, Bukusoglu C (1996) Propofol and ethanol produce additive hypnotic and anesthetic effects in the mouse. Anesth Analg 83:156–161CrossRefPubMedGoogle Scholar
  33. 33.
    Spies CD, Otter HE, Hüske B, Sinha P, Neumann T, Rettig J, Lenzenhuber E, Kox WJ, Sellers EM (2003) Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU. Intensive Care Med 29:2230–2238CrossRefPubMedGoogle Scholar
  34. 34.
    Sullivan JT, Sykora K, Schneidermann J, Naranjo CA, Sellers EM (1989) Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict 84:1353–1357CrossRefPubMedGoogle Scholar
  35. 35.
    Otter H, Martin J, Bäsell K et al (2005) Validity and reliability of the DDS for severity of delirium in the ICU. Neurocrit Care 2:150–158CrossRefPubMedGoogle Scholar
  36. 36.
    Martin J, Heymann A, Bäsell K et al (2010) Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version. Ger Med Sci 8:Doc02Google Scholar
  37. 37.
    Ely EW, Inouye SK, Bernard GR et al (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method forthe intensive care unit (CAM-ICU). JAMA 286:2703–2710CrossRefPubMedGoogle Scholar
  38. 38.
    Lütz A, Heymann A, Radtke FM (2010) Different assessment tools for intensive care delirium: which score to use? Crit Care Med 38:409–418CrossRefGoogle Scholar
  39. 39.
    Mueller SW, Preslaski CR, Kiser TH, Fish DN, Lavelle JC, Malkoski SP, MacLaren R (2014) A randomized, double-blind, placebo-controlled dose range study of dexmedetomidine as adjunctive therapy for alcohol withdrawal. Crit Care Med 42(5):1131–1139CrossRefPubMedGoogle Scholar
  40. 40.
    Wong A, Benedict NJ, Kane-Gill SL (2014) Multicenter evaluation of pharmacologic management and outcomes associated with severe resistant alcohol withdrawal. J Crit Care. https://doi.org/10.1016/j.jcrc.2014.10.008CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Hernandez M, Birnbach DJ, Van Zundert AA (2005) Anesthetic management of the illicit-substance-using patient. Curr Opin Anaesthesiol 18:315–324CrossRefPubMedGoogle Scholar
  42. 42.
    Schlatter J, Madras JL, Saulnier JL, Poujade F (1999) Drug interactions with methadone. Presse Med 28:1381–1384PubMedGoogle Scholar
  43. 43.
    Schmoldt A (2004) Arzneimittelinteraktionen bei substituierten Heroinabhängigen. Suchttherapie 5:162–166CrossRefGoogle Scholar
  44. 44.
    Kleinwächter R, Kork F, Weiß-Gerlach E et al (2010) Improving the detection of illicit substance use in preoperative anesthesiological assessment. Minerva Anesthesiol 76:29–37Google Scholar
  45. 45.
    Hoffman RS, Hollander JE (1997) Evaluation of patients with chest pain after cocain use. Crit Care Clin 13:809–828CrossRefPubMedGoogle Scholar
  46. 46.
    Hollander JE, Henry TD (2006) Evaluation and management of the patient who has cocaine-associated chest pain. Cardiol Clin 24:103–114CrossRefPubMedGoogle Scholar
  47. 47.
    Hyatt B, Bensky KP (1999) Illicit drugs and anesthesia. CRNA 10:15–23PubMedGoogle Scholar
  48. 48.
    Lange RA, Hillis LD (2001) Cardiovascular complications of cocaine use. N Engl J Med 345:351–358CrossRefPubMedGoogle Scholar
  49. 49.
    Steadman JL, Birnbach DJ (2003) Patients on party drugs undergoing anesthesia. Curr Opin Anaesthesiol 16:147–152CrossRefPubMedGoogle Scholar
  50. 50.
    Greene SL, Kerr F, Braitberg G (2008) Review article: amphetamines and related drugs of abuse. Emerg Med Australas 20(5):391–402CrossRefPubMedGoogle Scholar
  51. 51.
    Courtney KE, Ray LA (2014) Methamphetamine: an update on epidemiology, pharmacology, clinical phenomenology, and treatment literature. Drug Alcohol Depend 143:11–21CrossRefPubMedGoogle Scholar
  52. 52.
    Hawley LA, Auten JD, Matteucci MJ, Decker L, Hurst N, Beer W, Clark RF (2013) Cardiac complications of adult methamphetamine exposures. J Emerg Med 45(6):821–827CrossRefPubMedGoogle Scholar
  53. 53.
    Henry JA, Jeffreys KJ, Dawling S (1992) Toxicity and deaths from 3,4-methylenedioxymethamphetamine. Lancet 340:384–387CrossRefGoogle Scholar
  54. 54.
    Die Drogenbeauftragte der Bundesregierung, Bundesministerium für Gesundheit (BMG), Bundesärztekammer (BÄK) (2016) S3-Leitlinie Methamphetamin-bezogene Störungen, Konsultationsfassung. www.crystal-meth.aezq.de

Copyright information

© © Springer-Verlag GmbH Deutschland 2016

Authors and Affiliations

  1. 1.Klinik für Anästhesiologie m.S. operative IntensivmedizinCharité - Universitätsmedizin Campus Benjamin FranklinBerlinDeutschland
  2. 2.Klinik für Anästhesiologie m.S. operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-KlinikumCharité - UniversitätsmedizinBerlinDeutschland

Section editors and affiliations

  • Bernhard Zwißler
    • 1
  1. 1.Klinikum der Universität München, Klinik für AnästhesiologieMünchenGermany

Personalised recommendations