Perioperative management of the alcohol-dependent patient

Caring for the problem drinker in the perioperative period is a challenging task. If alcohol abuse is suspected, a careful assessment is indicated before surgery is performed. Both the CAGE and SMAST questionnaires are good screening tools for alcoholism. Preoperative evaluation of alcohol-dependent patients should include a complete blood count, blood urea nitrogen, serum electrolyte levels, creatinine and glucose levels, liver function tests, coagulation studies, an electrocardiogram and a chest radiograph. Smoking cessation and aggressive postoperative respiratory care are especially important for alcoholic patients who have chronic obstructive pulmonary disease. Elective surgery should not be considered in patients with acute hepatitis or cirrhosis, since the operative mortality rate is quite high in these patients. Alcohol withdrawal is managed primarily with benzodiazepines, although clonidine and beta blockers may also be beneficial.