ALCOHOL WITHDRAWAL - 02/09/11

Doi : 10.1016/S0025-7125(05)70372-2

Patrick H. Chang, MD ^a, Michael B. Steinberg, MD, MPH ^b

^a Department of Medicine, Division of General Internal Medicine, Jefferson Medical College, Philadelphia, Pennsylvania (PHC)

^b Department of Medicine, UMDNJ–Robert Wood Johnson School of Medicine, New Brunswick, New Jersey (MBS)

Résumé

Alcohol use disorders (AUDs) are pervasive problems worldwide. Physicians often do not detect AUDs, however, especially in the early stages.^{23 Cleary P.D., Miller M., Bush B.T. , et al. Prevalence and recognition of alcohol abuse in a primary care population Am J Med 1988 ; 85 : 466-471 [cross-ref]

Cliquez ici pour aller à la section Références, 24 Clement S. The identification of alcohol-related problems by general practitioners Br J Addict 1986 ; 81 : 257-264 [cross-ref]

Cliquez ici pour aller à la section Références, 29 Cyr M.G., Wartman S.A. The effectiveness of routine screening questions in the detection of alcoholism JAMA 1988 ; 259 : 51-54

Cliquez ici pour aller à la section Références, 53 Isaacson J.H., Butler R., Zacharek M. , et al. Screening with the alcohol use disorders identification test (AUDIT) in an inner-city population J Gen Intern Med 1994 ; 9 : 550-553 [cross-ref]

Cliquez ici pour aller à la section Références, 72 Moore R.D., Malitz F.E. Underdiagnosis of alcoholism by residents in an ambulatory medical practice J Med Educ 1986 ; 61 : 46-52 [cross-ref]

Cliquez ici pour aller à la section Références} When physicians do recognize the problem, they may not proceed with correct treatment strategies.^{13 Bush B., Shaw S., Cleary P. , et al. Screening for alcohol abuse using the CAGE questionnaire Am J Med 1987 ; 82 : 231-235 [cross-ref]

Cliquez ici pour aller à la section Références, 23 Cleary P.D., Miller M., Bush B.T. , et al. Prevalence and recognition of alcohol abuse in a primary care population Am J Med 1988 ; 85 : 466-471 [cross-ref]

Cliquez ici pour aller à la section Références, 25 Cohen M., Kern J.C., Hassett C. Identifying alcoholism in medical patients Hosp Commun Psychiatry 1986 ; 37 : 398-400

Cliquez ici pour aller à la section Références} This lack of detection and proper intervention is concerning because it can lead to adverse consequences in the perioperative and postoperative period. Various studies have noted increased postoperative morbidity in asymptomatic alcohol abusers.^{39 Felding C., Jensen L., Tonnesen H. Influence of alcohol intake on post-operative morbidity after hysterectomy Am J Obstet Gynecol 1992 ; 166 : 667-670

Cliquez ici pour aller à la section Références, 99 Spies C., Nordmann A., Brummer G. , et al. Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract Acta Anaesthesiol Scand 1996 ; 40 : 649-656 [cross-ref]

Cliquez ici pour aller à la section Références, 103 Stopinski J., Staib I., Weissbach M. Do nicotine and alcohol abuse affect the occurrence of postoperative bacterial infection? Langenbecks Arch Chir 1993 ; 378 : 125-128

Cliquez ici pour aller à la section Références, 110 Tonnesen H., Petersen K., Hojgaard L. , et al. Postoperative morbidity among symptom-free alcohol misusers Lancet 1992 ; 340 : 334-337

Cliquez ici pour aller à la section Références} This article helps health care providers to (1) recognize that AUDs represent a continuum of disease (i.e., it can present with a variety of symptoms and signs), (2) screen for AUDs preoperatively, (3) understand the pathophysiology behind alcohol-related postoperative complications, (4) provide a differential diagnosis of postoperative delirium, and (5) treat appropriately alcohol withdrawal syndrome (AWS).

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Plan

Address reprint requests to Patrick H. Chang, MD, Division of General Internal Medicine, Jefferson Medical College, 125 South 9th Street, 502 Sheridan Building, Philadelphia, PA 19107, e-mail: patrick.chang@mail.tju.edu