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Preanesthetic care. Intoxication and trauma

T D Watson, J F Lee

    Clinical Anesthesia
    |January 1, 1976
    PubMed
    Summary
    This summary is machine-generated.

    Anesthetic management for alcohol and drug abusers requires careful fluid therapy, early blood replacement, and monitoring for hypoglycemia and hypothermia. Certain anesthetic agents and CNS depressants should be avoided or reduced due to altered drug metabolism and effects.

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    Area of Science:

    • Anesthesiology
    • Pharmacology
    • Toxicology

    Background:

    • Alcohol and drug abuse significantly impacts patient physiology, affecting anesthetic management.
    • Chronic alcohol (ETOH) ingestion induces enzymes, altering anesthetic drug metabolism.
    • Intoxicated patients exhibit unique responses to surgical stress and anesthetic agents.

    Purpose of the Study:

    • To provide guidelines for the safe anesthetic management of alcohol and drug abusers.
    • To highlight physiological changes associated with substance abuse relevant to anesthesia.
    • To recommend specific modifications in anesthetic protocols for this patient population.

    Main Methods:

    • Review of physiological alterations in alcohol and drug abusers.
    • Analysis of pharmacokinetic and pharmacodynamic changes related to substance abuse.

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  • Synthesis of clinical observations and existing literature on anesthetic management.

    • Main Results:

    • Early blood replacement is indicated due to impaired hemorrhage tolerance.
    • Fluid therapy requires careful planning due to potential iso-osmotic overhydration.
    • Glucose supplementation is necessary to prevent hypoglycemia.
    • Anesthetic agents metabolized by induced enzymes (e.g., methoxyflurane, halothane) should be avoided.
    • Reduced supplementation of nitrous oxide-relaxant techniques with other depressants is advised.
    • Intraoperative core temperature monitoring and warming measures are crucial to prevent hypothermia.
    • Sympathomimetic drug effects can mask blood loss, making pulse and blood pressure unreliable indicators.

    Conclusions:

    • Anesthetic management for substance abusers necessitates tailored strategies addressing altered fluid balance, metabolism, and temperature regulation.
    • Careful selection of anesthetic agents and avoidance of certain drug combinations are essential.
    • Vigilant monitoring of physiological parameters and proactive interventions are critical for patient safety.