[Anesthesia and analgesia in opiate dependence]

This review is devoted to problems that can arise in analgesia and anesthesia in opiate addicts. The following factors are especially important: psychic disorders, heart, lung, liver and kidney disease, AIDS, and tolerance to opiates. Withdrawal of opiates during the perioperative period has a detrimental effect, and the addicted patient should therefore receive generous premedication. Practical experience in the United States of America has shown that the prophylactic administration of methadone is beneficial and prevents withdrawal symptoms. General anesthesia and regional anesthesia are both possible. It is possible to give opiates during general anesthesia achieved with preparations given by inhalation (isoflurane), but it must be borne in mind that high doses are necessary because of these patients' tolerance levels. When regional anesthesia is used for surgery or for postoperative anesthesia, it is important to observe the neurological contraindications. High doses of opiates can be administered (s.c., i.m., p.o., continuous infusion) for postoperative analgesia in opiate addicts with no fear of respiratory depression, with further analgesic treatment as and when necessary (antidepressants, anti-inflammatory agents, neuroleptics, electroacupuncture). Attention is drawn to clonidine as a particularly good drug for the treatment of opiate withdrawal. Problems encountered with abstinent drug addicts are discussed.