Concerns of Addiction to Anaesthesiologists in the Perioperative Period

Abstract

Drug abuse has a huge impact in the perioperative care of any addicted patient. Not only does it translate into increased costs, but also several medico-legal and socio-cultural problems. Bringing out a positive history of addiction or drug abuse can be a challenging task and urinary drug testing (UDS) has its own limitations. The complications following intravenous drug abuse are mainly three-fold: effects due to drug-toxicity; effects related to administration route; and effects arising out of social implications of drug-dependence [2]. The anesthesiologists could take the responsibility for initiation of quitting the habit by creating awareness about its ill-effects on various body systems, including infections (cellulitis, endocarditis, abscesses and viremia), aneurysms and non-healing ulcers. They can highlight about the higher propensity for peri-operative complications. Pre-anesthetic visit must be elaborate, both in terms of time and assessment. Most of these patients would need intensive monitoring peri operatively. Many of them would require greater than normal doses of anesthetic and analgesic agents. The key to success lies in creating a fine balance, by avoiding both underand over dosage. Ensuring adequate post-operative analgesia is of paramount importance, to prevent relapse to addiction by insufficient analgesia [3]. Anesthesiologists must also be prepared to deal with withdrawal and abstinence syndrome. Greater care needs to taken in cases of combination or multiple drug addiction. To cement the impact of peri-operative counseling against drug addiction, long term follow-up advice and social support systems must be provided to these patients.