[Managing anesthesia in the alcoholic patient]

In most developed countries, alcohol is a socially tolerated drug. Nevertheless, its consumption is associated with several negative side-effects during anaesthesia. In surgical patients the prevalence of alcoholism exceeds 20%. Chronic alcoholism and acute alcoholism have an important impact on perioperative morbidity and mortality and especially on anaesthetic risk, due to pharmacological interactions, pathophysiological changes and direct pharmacological interactivities between alcohol and narcotics. Symptoms of alcohol withdrawal are a serious and potentially life-threatening complication and should be avoided or the risk for occurrence should at least be reduced. Patients with a high risk of developing perioperative symptoms of alcohol withdrawal can be detected by laboratory tests and questionnaires. The most important implication for anaesthesia is the choice of a rapid sequence induction to reduce the risk of aspiration and the maintenance of haemodynamic stability and liver perfusion. Maintaining body temperature and providing intensive postoperative surveillance and care are necessary. The indications for regional anaesthesia are the same as for other patients (cooperativeness, coagulation, consent, etc.). In general, awareness of possible interactions can reduce perioperative complications and improve postoperative outcome.