Anesthesia Considerations for Patients Who Regularly Drink Alcohol

Whether a patient consumes healthy amounts of alcohol regularly or suffers from alcohol abuse, anesthesia providers must alter their strategy before, during, and after surgery to promote the best outcomes. 

In the preoperative period, understanding the patient’s history of alcohol consumption is paramount [1]. Adults and adolescents should be administered an established fluid questionnaire, such as those designed by the National Institute on Alcohol Abuse and Alcoholism, to track past and present consumption patterns [1]. If a patient suffers from chronic alcohol misuse, elective operations may need to be more carefully considered in light of heightened risk [2]. Ideally, patients should abstain from drinking for six to eight weeks before surgery to minimize their risk of complications [2]. To achieve successful preoperative sobriety, clinicians can refer the patient to a withdrawal program [2].

Before the operation, clinicians should examine the patients’ nervous system, cardiovascular system, and liver to test whether the patient shows indications of diminished cognitive function, impaired vision, autonomic or peripheral neuropathies, difficulties with coordination, cardiac failure, arrhythmias, and hypertension [1]. An EKG and chest x-ray may be appropriate [1].

Following these examinations, the anesthesia provider must determine what type of anesthesia at what level of dosage is appropriate for the patient [3]. Alcohol’s deleterious effect on liver function makes it more difficult for the liver to metabolize anesthetic agents [3]. Alcohol users also experience relatively blunted nerve receptors, so they can possibly achieve the numbing effects of anesthesia with less medication [3]. Consequently, patients with a history of chronic alcohol usage may require lower doses of anesthesia [3, 4]. However, the effects of specific anesthetic agents may change the anesthesia provider’s approach to dosage. For instance, research found that alcoholic patients required a higher induction dose of propofol on average, suggesting that the “less is more” rule does not always apply [5].

During surgery, patients with a history of alcohol consumption are likely to benefit from rapid sequence induction to prevent intraoperative complications [1]. Because alcohol can lower a patient’s blood pressure (BP), especially if consumed in the period leading up to surgery, anesthesia providers must be careful to track BP throughout the procedure [3]. For chronic alcohol users, intraoperative alcohol withdrawal syndrome (AWS) may be possible [6]. Although researchers have yet to identify the causes of intraoperative AWS with certainty, anesthesia providers should anticipate its occurrence, especially if they note local anesthetic systemic toxicity [6]. 

Anesthesia providers and surgeons must be attentive to potential postoperative complications, particularly in patients with substance dependence or who were not sober before surgery. Chronic alcohol users have a 2- to 5-fold greater risk of complication [1]. AWS may result in adverse cardiovascular or neurological events such as delirium, tachycardia, and seizures [7]. Other complications, such as bleeding, heightened stress responses, and immune deficiency, can also occur [1]. Some of these symptoms can be treated with benzodiazepines, thiamine supplementation, or, more rarely, propofol [2, 7]. 

Because the range of alcohol-related complications is great and the risk high, a patient’s history with drinking must be a major consideration for all anesthesia providers throughout the surgical process. Although the likelihood of adverse events varies depending on how often and how much a patient drinks, clinicians should never ignore these considerations when alcohol is a prominent part of a patient’s lifestyle. 

References 

[4] B. Wolfson and B. Freed, “Influence of Alcohol on Anesthetic Requirements and Acute Toxicity,” Anesthesia & Analgesia, vol. 59, no. 11, p. 826-830, November 1980. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/7191671/. 

[5] J. I. Choi et al., “Effects of chronic alcohol consumption on propofol-induced sedation in spinal anesthesia,” European Journal of Anaesthesiology, vol. 22, no. 1, p. 98, May 2005. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/7191671/. 

[3] M. Fathi, “Anesthetic Considerations for Alcohol Using Patients,” Asia Pacific Journal of Medical Toxicology, vol. 3, supp. 1, p. 17, May 2014. [Online]. Available: http://www.doi.org/10.22038/APJMT.2014.2896. 

[2] T. Blincoe and D. Chambler, “Alcohol and anaesthesia,” British Journal of Hospital Medicine, vol. 80, no. 8, August 2019. [Online]. Available: http://www.doi.org/10.12968/hmed.2019.80.8.485. 

[7] C. Adams, “Anaesthetic implications of acute and chronic alcohol abuse,” Southern African Journal of Anaesthesia and Analgesia, vol. 16, no. 3, p. 42-49, November 2010. [Online]. Available: http://www.doi.org/10.1080/22201173.2010.10872680. 

[6] A. Subedi and B. Bhattarai, “Intraoperative Alcohol Withdrawal Syndrome: A Coincidence or Precipitation?,” Case Reports in Anesthesiology, vol. 2013, no. 3, p. 1-3, July 2013. [Online]. Available: http://www.doi.org/10.1155/2013/761527. 

[1] R. Chapman and F. Plaat, “Alcohol and anaesthesia,” Continuing Education in Anaesthesia, Critical Care & Pain, vol. 9, no. 1, p. 1-3, December 2009. [Online]. Available: http://www.doi.org/:10.1093/bjaceaccp/mkn045.