RT Book, Section
A1 Pagel, Paul S.
A1 May, Judith A.
A2 Longnecker, David E.
A2 Mackey, Sean C.
A2 Newman, Mark F.
A2 Sandberg, Warren S.
A2 Zapol, Warren M.
SR Print(0)
ID 1144114470
T1 The Patient With a Substance Use Disorder
T2 Anesthesiology, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071848817
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144114470
RD 2024/04/20
AB KEY  POINTSSubstance  use  disorder  is  a  common  disease.  It  is  characterized  by  loss  of  control  over  a  substance  of  abuse,  including  an  inability  to  voluntarily  self-regulate  substance  use,  compulsive  preoccupation  with  obtaining  or  using  a  substance,  and  continued  use  despite  adverse  consequences.Substance  use  disorder  may  be  managed  successfully  as  a  chronic  disease,  and  many  patients  respond  positively  to  treatment  with  long  periods  of  abstinence.Consultation  with  an  addiction  medicine  specialist  is  encouraged  when  providing  care  for  active  or  recovering  patients  with  substance  use  disorder  during  the  perioperative  period.Preoperative  assessment  of  all  patients  presenting  for  surgery  should  include  a  routine  evaluation  for  substance  use  disorder.Establishing  a  supportive,  nonjudgmental  but  firm  approach  to  the  patient  with  active  substance  use  disorder  is  vital  for  successful  care.Preoperative  history,  physical  examination,  and  laboratory  testing  should  be  guided  by  the  known  medical  consequences  of  substance  use  disorder.A  blood  alcohol  concentration  and  a  urine  drug  screen  should  be  obtained  in  all  active  and  most  recovering  patients  with  substance  use  disorder.Polysubstance  abuse  is  common.Infectious  diseases  are  epidemic  in  injection  drug  users.Alcohol  abuse  has  extensive  medical  consequences  that  affect  every  major  organ  system  and  is  a  major  risk  factor  for  perioperative  morbidity  and  mortality.Abuse  of  sedative-hypnotics,  opioids,  cocaine,  amphetamines,  cannabis,  hallucinogens,  and  inhalants  is  associated  with  a  wide  variety  of  drug-specific  medical  complications.Withdrawal  is  commonly  encountered  during  the  perioperative  period  in  patients  with  substance  use  disorder,  and  prophylaxis  against  withdrawal  should  be  instituted  before  surgery.Recovery  involves  abstinence  in  combination  with  a  series  of  personal  changes  to  maintain  sobriety.