Perioperative Management Of Patients With Alcohol Dependence


A.Ye. Muronov

Kuban State Medical University, Krasnodar, Russia

For correspondence: Alexey Ye. Muronov — M.D., assistant professor, Department of anesthesiology, intensive care and transfusiology of Kuban State Medical University, Krasnodar, Russia; e-mail:

For citation: Muronov AYe. Perioperative Management of Patients with Alcohol Dependence. Intensive Care Herald. 2017;2:61–68.

The review article covers the issues of perioperative management of patients with alcohol dependence. Particular attention is paid to the most common methods of diagnosing alcohol dependence: the collection of anamnesis and the detection of the amount of alcohol consumed, the use of special questionnaires, direct and indirect laboratory criteria, prevention of development and therapy of alcohol withdrawal syndrome and alcoholic delirium, and infectious complications.

Keywords: alcohol dependence, perioperative period, alcohol withdrawal syndrome

Received: 12.04.2017


  1. Schwartz A., Knez D. Anestesia and Alcohol Addiction. In: Bryson E.O., Frost E.A.M. Perioperative Addiction. Clinical Management of the Addicted Patient. Springer Science + Business Media, LLC,
  2., accessed 04.04.2017
  3. Кошкина Е.А., Киржанова В.В. Эпидемиология наркологических заболеваний. В кн.: Наркология: национальное руководство: под ред. Н.Н. Иванца, И.П. Анохиной, М.А. Винниковой. М.: ГЭОТАР-Медиа, 2008. [Koshkina E.A., Kirzhanova V.V. Epidemiologiya narkologicheskih zabolevanii. In: Narkologiya: natsional’noe rukovodstvo: eds. N.N. Ivanets, P. Anokhina, M.A. Vinnikova. Moscow: GEOTAR-Media, 2008. (In Russ)]
  4. Holt R., Ramos J., Harma M.A. et al. Prevalence of unhealthy substance use on teaching and hospitalist medical services: implications for education. Am. J. Addict. 2012, 21: 111–119. doi: 10.1111/j.1521-0391.2011.00207.x.
  5. Spies C.D., Neuner B., Neumann et al. Intercurrent complications in chronic alcoholic men admitted to the intensive care unit following trauma. Intensive Care Med. 1996; 22: 286–293.
  6. Spies C.D., 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.
  7. Spies C.D., Rommelspacher H. Alcohol withdrawal in the surgical patient: prevention and treatment. Anesth. Analg. 1999; 88: 946–954.
  8. Spies C.D., von Dossow , Eggers V. et al. Altered cell-mediated immunity and increased postoperative infection rate in long-term alcoholic patients. Anesthesiology. 2004; 100: 1088–1100. doi: 10.1097/
  9. Sorensen T., Jorgensen T., Kirkeby L.T. et al. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br. J. Surg. 1999; 86: 927–931.
  10. Заболотских И.Б., Трембач Н.В., Муронов А.Е., Синьков С.В., Малышев Ю.П. Периоперационное ведение пациентов с сопутствующей дыхательной недостаточностью. В кн: Периоперационное ведение пациентов с сопутствующими заболеваниями. Руководство для врачей: в 3 т.: под ред. И.Б. Заболотских. Т. 2-е изд., перераб. и доп. М.: Практическая медицина, 2016. [Zabolotskikh I.B., Trembach N.V., Muronov A.Ye., Sinkov S.V., Malyshev Yu.P. Perioperatsionnoe vedenie patsientov s soputstvuyushchei dyhatel’noi nedostatochnost’yu. In: Perioperatsionnoe vedenie patsientov s soputstvuyushchimi zabolevaniyami. Rukovodstvo dlya vrachei: in 3 vol.: ed. I.B. Zabolotskikh. Vol. 1. 2nd ed. Moscow: Prakticheskaya meditsina, 2016. (In Russ)]
  11. Roche A.M., Freeman , Skinner N. From data to evidence, to action: findings from a systematic review of hospital screening studies for high risk alcohol consumption. Drug Alcohol Depend. 2006; 83: 1–14. doi: 10.1016/j.drugalcdep.2005.10.011.
  12. Makdissi R., Stewart S.H. Care for hospitalized patients with unhealthy alcohol use: a narrative review. Addiction Science & Clinical 2013; 8: 11. doi: 10.1186/1940-0640-8-11.
  13. Veit A.M. Гл. Алкоголизм. В кн.: Дюк Д. Секреты анестезии: пер. с англ.: под общ. ред. А.П. Зильбера, В.В. Малышева. М.: МЕДпресс-информ, 2005. [Veit A.M. Ch. 52. Alcoholism. In: Duk D. Secrets of anesthesia: transl. from English: eds. A.P. Zilber, V.V. Malyshev. Moscow: MEDpress-inform, 2005. (In Russ)]
  14. Pulley D. Preoperative evaluation of the patient with substance use disorder and perioperative considerations. Anesthesiology clinics. 2016: 34(1): 201–211. doi: 10.1016/j.anclin.2015.10.015.
  15. Dawson D.A., Grant F., Li T.K. Quantifying the risks associated with exceeding recommended drinking limits. Alcohol Clin. Exp. Res. 2005; 29(5): 902–908.
  16. National Institute on Alcohol Abuse and Alcoholism: Helping patients who drink too much: A clinician’s US Department of Health and Human Services, 2005.
  17. Tonnesen , Kehlet H. Preoperative alcoholism and postoperative morbidity. Br. J. Surg. 1999; 86: 869–874.
  18. Петров Д.В. Диагностика, лечение и профилактика расстройств, вызванных употреблением алкоголя. Ярославль, 2003: 90–92. [Petrov D.V. Diagnostika, lechenie i profilaktika rasstroistv, vyzvannyh upotrebleniem alkogolya. Yaroslavl, 2003: 90–92. (In Russ)]
  19. Заболотских И.Б., Величко Д.С., Голубцов В.В. и др. Периоперационное ведение больных с сопутствующими заболеваниями: руководство для врачей: в 3 т. М.: Практическая медицина, Т. 2. [Zabolotskikh I.B., Velichko D.S., Golubtsov V.V. et al. Perioperatsionnoe vedenie patsientov s soputstvuyushchimi zabolevaniyami: rukovodstvo dlya vrachei: in 3 vol. Moscow: Prakticheskaya meditsina, 2014. Vol. 2. (In Russ)]
  20. Пронько П.С. Биомаркеры в диагностике алкоголизма. Вестник Национальной академии наук Беларуси. 2009; 2: 103–115. [Pron’ko S. Biomarkery v diagnostike alkogolisma. Vestnik Natsional’noi akademii nauk Belarusi. 2009; 2; 103–115. (In Russ)]
  21. Огурцов П.П., Жиров В.П. Неотложная алкогольная патология. СПб., 2002. [Ogurtsov P.P., Zhirov V.P. Neotlozhnaya alkogol’naya patologiya. Saint Petersburg, 2002. (In Russ)]
  22. Aakeroy R., Skrastad R.B., Helland A. et al. Nye markorer for pavisning av alkoholbruk. Tidsskr Nor Legeforen 19. 2016; 136: 1643–1647. doi: 10.4045/tidsskr.16.0056.
  23. Kummer N., Wille S.M.R., Poll A. et al. Quantification of EtG in hair, EtG and EtS in urine and PEth species in capillary dried blood spots to assess the alcohol consumption in driver’s licence regranting cases. Drug and Alcohol Dependence. 2016; 165: 191–197. doi: 1016/j.drugalcdep.2016.06.012.
  24. Заболотских И.Б., Мусаева Т.С., Богданов Е.В., Голубцов В.В. Метод регистрации постоянного потенциала в периоперативной оценке нарушений водно-электролитного обмена. Кубанский научный медицинский вестник. 2009; 7: 61–67. [Zabolotskikh I.B., Musaeva T.S., Bogdanov E.V., Golubtsov V.V. Metod registratsii postoyannogo potentsiala v perioperativnoi otsenke narushenii vodno-elektrolitnogo balansa. Kubanskii nauchnyi meditsinskii vestnik. 2009; 7: 61–67. (In Russ)]
  25. Thomson A.D., Cook C.C., Touquet et al. The Royal College of Physicians report on alcohol: guidelines for managing Wernicke’s encephalopathy in the accident and emergency department. Alcohol Alcohol. 2002; 37: 513–521.
  26. Spies C.D., Dubisz N., Funk et al. Prophylaxis of alcohol withdrawal syndrome in alcohol-dependent patients admitted to the intensive care unit after tumour resection. Br. J. Anaesth. 1995; 75: 734–739.
  27. Kork , Neumann T., Spies C. Perioperative management of patients with alcohol, tobacco and drug dependency. Curr. Opin. Anaesthesiol. 2010; 23: 384–390. doi: 10.1097/ ACO.0b013e3283391f79.
  28. Spies C., Eggers , 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 Med. 2006; 174: 408–414. doi: 10.1164/rccm.200506-907OC.
  29. Lau A., von Dossow , Sander M. et al. Alcohol use disorder and perioperative immune dysfunction. Anesth. Analg. 2009; 108: 916–920.
  30. Moss M., Burnham E.L. Alcohol abuse in the critically ill patient. Lancet. 2006; 368: 2231–2242. doi: 10.1016/S0140- 6736(06)69490-7.
  31. Spies C.D., Sander M., Stangl K. et al. Effects of alcohol on the heart. Opin. Crit. Care. 2001; 7: 337–343.
  32. Tonnesen , Rosenberg J., Nielsen H.J. et al. Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial. BMJ. 1999; 318: 1311.
  33. Заболотских И.Б., Зыбин К.Д., Курзанов А.Н., Мусаева Т.С. Сверхмедленные биопотенциалы как способ экспресс-диагностики типа энергодефицита у реанимационных больных. Кубанский научный медицинский вестник. 2009; 1: 37–42. [Zabolotskikh I.B., Zybin K.D., Kurzanov A.N., Musaeva T.S. Sverhmedlennye biopotentsialy kak sposob ekspress-diagnostiki tipa energodefitsita u reanimatsionnyh bol’nyh. Kubanskii nauchnyi meditsinskii 2009; 1; 37–42. (In Russ)]
  34. Заболотских И.Б., Синьков С.В., Аверьянова Л.Б. Синдром диссеминированного внутрисосудистого свертывания крови: диагностика и интенсивная терапия Анестезиология и реаниматология. 2007; 2: 75–80. [Zabolotskikh I.B., Sinkov S.V., Averyanova L.B. Sindrom disseminirovannogo vnutrisosudistogo svertyvaniya krovi: diagnostika i intensivnaya terapiya. Anesteziologiya i 2007; 2; 75–80. (In Russ)]
  35. Шапошников С.А., Чернов В.Н., Заболотских И.Б. Послеоперационные тромботические осложнения. Статистический анализ за 50 лет. Анестезиология и реаниматология. 2004; 3: 21–24. [Shaposhnikov S.A., Chernov V.N., Zabolotskikh I.B. Posleoperatsionnye tromboticheskie oslozhneniya. Statisticheskii analiz za 50 let. Anesteziologiya i reanimatologiya. 2004; 3; 21–24. (In Russ)]
  36. Заболотских И.Б., Синьков С.В., Шапошников С.А. Выбор антикоагулянта в зависимости от стадии ДВС-синдрома. Анестезиология и реаниматология. 2004; 3: 29–32. [Zabolotskikh I.B., Sinkov S.V., Shaposhnikov S.A. Vybor antikoagulyanta v zavisimosti ot stadii DVS-sindroma. Anesteziologiya i reanimatologiya. 2004; 3; 29–32. (In Russ)]
  37. Spies C., Tonnesen , Andreasson S. et al. Perioperative morbidity and mortality in chronic alcoholic patients. Alcohol Clin. Exp. Res. 2001; 25(5 Suppl ISBRA): 164S–170S.
  38. Lonergan E., Luxenberg J., Areosa Sastre A. Benzodiazepines for delirium. Cochrane Database Syst. 2009: CD006379. doi: 10.1002/14651858.CD006379.pub3.
  39. Spies C.D., Otter H.E., Huske B. et al. Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU. Intensive Care Med. 2003; 29: 2230–2238. doi: 10.1007/s00134-003-2033-3.
  40. Brathen , Ben-Menachem E., Brodtkorb E. et al. EFNS guideline on the diagnosis and management of alcohol-related seizures: report of an EFNS task force. Eur. J. Neurol. 2005; 12: 575–581. doi: 10.1111/j.1468-1331.2005.01247.x.
  41. Linn D., Loeser K.C. Dexmedetomidine for Alcohol Withdrawal Syndrome: A Review of the Literature. Annals of Pharmacotherapy. 2015; 49(12): 1336–1342. doi:10.1177/1060028015607038.
  42. Tonnesen , Nielsen P.R., Lauritzen J.B., Moller A.M. Smoking and alcohol intervention before surgery: evidence for best practice. Br. J. Anaesth. 2009; 102: 297–306. doi: 10.1093/bja/ aen401.
  43. Mayo-Smith F. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA. 1997; 278: 144–151.
  44. Mayo-Smith F., Beecher L.H., Fischer T.L. et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Archives of Internal Medicine. 2004; 164: 1405–1412. doi: 10.1001/archinte.164.13.1405.
  45. Amato L., Minozzi S., Vecchi S., Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst. 2010; 17(3): CD005063. doi: 10.1002/14651858.CD005063.pub3.
  46. Schmidt K.J., Doshi M.R., Holzhausen J.M. et al. Treatment of Severe Alcohol Withdrawal. Annals of Pharmacotherapy. 2016; 50(5): 389–401.
  47. Katzung B., Trevor (eds.) Basic and Clinical Pharmacology. 13th ed. New York, NY: McGraw-Hill, 2015.
  48. Sullivan T., Sykora K., Schneiderman J., Naranjo C.A., Sellers E.M. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br. J. Addict. 1989; 84: 1353–1357.
  49. Duby J.J., Berry A.J., Ghayyem et al. Alcohol withdrawal syndrome in critically ill patients: Protocolized versus nonpro- tocolized management. J. Trauma Acute Care Surg. 2014; 77: 938–943. doi: 10.1097/TA.0000000000000352.
  50. Gold J.A., Rimal B., Nolan A., Nelson L.S. A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit. Care Med. 2007; 35: 724–730. doi: 10.1097/01. CCM.0000256841.28351.80.
  51. DeCarolis D.D., Rice K.L., Ho L. et al. Symptom-driven lorazepam protocol for treatment of severe alcohol withdrawal delirium in the intensive care Pharmacotherapy. 2007; 27: 510–518. doi: 10.1592/phco.27.4.510.
  52. Заболотских И.Б., Рудомёткин С.Г., Трембач Н.В. Послеоперационный делирий у пожилых пациентов: обзор литературы Вестник интенсивной терапии. 2013; 1: 62–69. [Zabolotskikh I.B., Rudometkin S.G., Trembach V. Posleoperatsionnyi delirii u pozhilyh patsientov: obzor literatury. Vestnik intensivnoi terapii. 2013; 1: 62–69. (In Russ)]
  53. Заболотских И.Б., Рудомёткин С.Г., Трембач Н.В. Предоперационные факторы риска развития делирия у пожилых пациентов после обширных абдоминальных операций. Вестник анестезиологии и реаниматологии. 2012; 9(4): 3–7. [Zabolotskikh I.B., Rudometkin S.G., Trembach N.V. Predoperatsionnye faktory riska razvitiya deliriya u pozhilyh patsientov posle obshirnyh abdominal’nyh operatsii. Vestnik intensivnoi terapii. 2012; 9(4): 3–7. (In Russ)]
  54. Hack J.B., Hoffmann R.S., Nelson L.S. Resistant alcohol withdrawal: does anunexpectedly large sedative requirement identify these patients early? J. Med. 2006; 2: 55–60.
  55. Rosenson J., Clements C., Simon B. et al. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study. J. Emerg. Med. 2013; 44: 592–598. doi: 1016/j.jemermed.2012.07.056.
  56. Wong A., Benedict N.J., Lohr B.R. et al. Management of benzodiazepine-resistant alcohol withdrawal across a healthcare system: benzodiazepine dose escalation with or without propofol. Drug. Alcohol Depend. 2015; 154: 296–299. doi: 10.1016/j. drugalcdep.2015.07.005.
  57. Lorentzen K., Lauritsen A.O., Bendtsen A.O. Use of propofol infusion in alcohol withdrawal-induced refractory delirium tremens. Dan. Med. J. 2014; 61:
  58. Sohraby R., Attridge R.L., Hughes D.W. Use of propofol-containing versus benzodiazepine regimens for alcohol withdrawal requiring mechanical ventilation. Ann. Pharmacother. 2014; 48: 456–461. doi: 1177/1060028013515846.
  59. Takeshita J. Use of propofol for alcohol withdrawal delirium: a case J. Clin. Psychiatry. 2004; 65(1): 134–135.
  60. Minozzi S., Amato L., Vecchi S., Davoli M. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst. 2010: CD005064. doi: 10.1002/14651858.CD005064.pub3.
  61. Wong A., Benedict N.J., Armahizer M.J., Kane-Gill S.L. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann. Pharmacother. 2015; 49: 14–19. doi: 10.1177/1060028014555859.
  62. Гельфанд Б.Р., Линев Д.В., Ярошецкий А.И., Ивахник Д.И. Делирий у пациентов в критических состояниях. В кн: Острые психические расстройства в интенсивной терапии: практ. руководство для анестезиологов-реаниматологов, хирургов, неврологов, психиатров: под ред. Б.Р. Гельфанда, В.Н. Краснова. – М.: Медицинское информационное агентство, 2014. [Gelfand B.R., Linev D.V., Yaroshetskii A.I., Ivakhnik D.I. Delirii u patsientov v kritichestih sostoyaniyah. In: Ostrye psihicheskie rasstroistva v intensivnoi terapii: prakt. rukovodstvo dlya anesteziologov-reanimatologov, hirurgov, nevrologov, psihiatrov: eds.: B.R. Gel’fand, V.N. Krasnov. Moscow: Meditsinskoe informatsionnoe agentstvo, (In Russ)]
  63. Рудомёткин С.Г., Трембач Н.В., Заболотских И.Б., Оноприев В.И. Предоперационные и интраоперационные факторы риска развития делирия у пожилых пациентов после обширных абдоминальных операций. Кубанский научный медицинский вестник. 2012; 3: 121–128. [Rudometkin S.G., Trembach N.V., Zabolotskikh I.B., Onopriev V.I. Predoperatsionnye i intraoperatsionnye faktory riska razvitiya deliriya u pozhilyh patsientov posle obshirnyh abdominal’nyh operatsii. Kubanskii nauchnyi meditsinskii 2012; 3: 121–128. (In Russ)]
  64. Gerlach T., Murphy C.V., Dasta J.F. An updated focused review of dexmedetomidine in adults. Ann. Pharmacother. 2009; 43: 2064–2074. doi: 10.1345/aph.1M310.
  65. Mueller W., Preslaski C.R., Kiser T.H. et al. A randomized, double-blind, placebo-controlled dose range study of dexmedetomidine as adjunctive therapy for alcohol withdrawal. Crit. Care Med. 2014; 42: 1131–1139. doi: 10.1097/CCM.0000000000000141.
  66. Tolonen , Rossinen J., Alho H., Harjola V.P. Dexmedetomidine in addition to benzodiazepine-based sedation in patients with alcohol withdrawal delirium. Eur. J. Emerg. Med. 2013; 20: 425–427. doi: 10.1097/MEJ.0b013e32835c53b3.
  67. Martin , Heymann A., Basell K. et al. S3-Leitlinie zu analgesie, sedierung und delirmanagement in der intensivmedizin. Ger. Med. Sci. 2010; 8: Doc02.
  68. Григорьев С.В., Заболотских И.Б., Магомедов М.А. и др. Периоперационное ведение больных с сопутствующими заболеваниями: руководство для врачей: в 3 т. М.: Практическая медицина, Т. 1. [Grigorev S.V., Zabolotskikh I.B., Magomedov M.A. Perioperatsionnoe vedenie bol’nyh s soputstvuyushchimi zabolevaniyami: rukovodstvo dlya vrachei: in 3 vol.: ed. I.B. Zabolotskikh. Moscow: Prakticheskaya meditsina, 2011. (In Russ)]