Improved Outcomes in Patients With Head and Neck Cancer Using a Standardized Care Protocol for Postoperative Alcohol Withdrawal

Lansford, Christopher D.; Guerriero, Cathleen H.; Kocan, Mary Jo; Turley, Richard Marggraf; Groves, Michael W.; Bahl, Vinita; Abrahamse, Paul; Bradford, Carol R.; Chepeha, Douglas B.; Moyer, Jeffrey S.; Prince, Mark; Wolf, Gregory T.; Aebersold, Michelle; Teknos, Theodoros N.

doi:10.1001/archotol.134.8.865

Cited by 37 publications

(37 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…model is that AWiMA is more pronounced, longer-lasting and stable when compared to mice withdrawn from alcohol administered on a voluntary basis (compare Figure 1 and Figure 4). Clonidine, a centrally acting α2A-adrenergic receptor agonist clinically used in the treatment of alcohol withdrawal symptoms (Bjorkqvist, 1975; Lansford et al, 2008; Martin et al, 2006; Muzyk et al, 2011), produced potent analgesia in our alcohol withdrawal model, thereby also providing our model with construct validity.…”

Section: Discussionmentioning

confidence: 94%

Involvement of delta opioid receptors in alcohol withdrawal-induced mechanical allodynia in male C57BL/6 mice

Alongkronrusmee

Chiang

Rijn

2016

Drug and Alcohol Dependence

View full text Add to dashboard Cite

Background As a legal drug, alcohol is commonly abused and it is estimated that 17 million adults in the United States suffer from alcohol use disorder. Heavy alcoholics can experience withdrawal symptoms including anxiety and mechanical allodynia that can facilitate relapse. The molecular mechanisms underlying this phenomenon are not well understood, which stifles development of new therapeutics. Here we investigate whether delta opioid receptors (DORs) play an active role in alcohol withdrawal-induced mechanical allodynia (AWiMA) and if DOR agonists may provide analgesic relief from AWiMA. Methods To study AWiMA, adult male wild-type and DOR knockout C57BL/6 mice were exposed to alcohol by a voluntary drinking model or oral gavage exposure model, which we developed and validated here. We also used the DOR-selective agonist TAN-67 and antagonist naltrindole to examine the involvement of DORs in AWiMA, which was measured using a von Frey model of mechanical allodynia. Results We created a robust model of alcohol withdrawal-induced anxiety and mechanical allodynia by orally gavaging mice with 3 g/kg alcohol for three weeks. AWiMA was exacerbated and prolonged in DOR knockout mice as well as by pharmacological blockade of DORs compared to control mice. However, analgesia induced by TAN-67 was attenuated during withdrawal in alcohol-gavaged mice. Conclusions DORs appear to play a protective role in the establishment of AWiMA. Our current results indicate that DORs could be targeted to prevent or reduce the development of AWiMA during alcohol use; however, DORs may be a less suitable target to treat AWiMA during active withdrawal.

show abstract

Section: Discussionmentioning

confidence: 94%

Involvement of delta opioid receptors in alcohol withdrawal-induced mechanical allodynia in male C57BL/6 mice

Alongkronrusmee

Chiang

Rijn

2016

Drug and Alcohol Dependence

View full text Add to dashboard Cite

show abstract

“…3 Patients with delays in recognition and management had worse outcomes. [3][4][5][6] In this project, all adult inpatients were screened for risk of alcohol withdrawal syndrome at the time of admission. This contributed to early identification of patients needing further monitoring or treatment.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Early intervention and symptomtriggered dosing is recommended in managing alcohol withdrawal and preventing DT. 5,6 The management of patients with alcohol withdrawal syndrome is a challenging and resource-intensive process.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Improving Alcohol Withdrawal Outcomes in Acute Care

Melson

Kane

Mooney

et al. 2014

TPJ

View full text Add to dashboard Cite

“…and (4) Have you ever felt you needed a drink first thing in the morning ( E ye‐opener) to steady your nerves or to get rid of a hangover? If one of the CAGE questions is endorsed, then investigation of an alcohol use disorder through a structured clinical interview is warranted. Although the CAGE questionnaire can be used in the institutional setting, it may have limited utility in the ICU because of its failure to predict severity of AWS or outcomes . One study used the CAGE questionnaire in 652 surgical oncology ICU patients to screen for alcohol dependence .…”

Section: Overview Of Alcohol Withdrawal Syndromementioning

confidence: 99%

Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients

et al. 2016

View full text Add to dashboard Cite

Approximately 16-31% of patients in the intensive care unit (ICU) have an alcohol use disorder and are at risk for developing alcohol withdrawal syndrome (AWS). Patients admitted to the ICU with AWS have an increased hospital and ICU length of stay, longer duration of mechanical ventilation, higher costs, and increased mortality compared with those admitted without an alcohol-related disorder. Despite the high prevalence of AWS among ICU patients, no guidelines for the recognition or management of AWS or delirium tremens in the critically ill currently exist, leading to tremendous variability in clinical practice. Goals of care should include immediate management of dehydration, nutritional deficits, and electrolyte derangements; relief of withdrawal symptoms; prevention of progression of symptoms; and treatment of comorbid illnesses. Symptom-triggered treatment of AWS with γ-aminobutyric acid receptor agonists is the cornerstone of therapy. Benzodiazepines (BZDs) are most studied and are often the preferred first-line agents due to their efficacy and safety profile. However, controversy still exists as to who should receive treatment, how to administer BZDs, and which BZD to use. Although most patients with AWS respond to usual doses of BZDs, ICU clinicians are challenged with managing BZD-resistant patients. Recent literature has shown that using an early multimodal approach to managing BZD-resistant patients appears beneficial in rapidly improving symptoms. This review highlights the results of recent promising studies published between 2011 and 2015 evaluating adjunctive therapies for BZD-resistant alcohol withdrawal such as antiepileptics, baclofen, dexmedetomidine, ethanol, ketamine, phenobarbital, propofol, and ketamine. We provide guidance on the places in therapy for select agents for management of critically ill patients in the presence of AWS.

show abstract

Improved Outcomes in Patients With Head and Neck Cancer Using a Standardized Care Protocol for Postoperative Alcohol Withdrawal

Abstract: To show clinical benefit in the main outcome measures by the use of a standardized protocol for identification, characterization, and treatment of alcohol withdrawal syndrome (AWS) in postoperative patients with head and neck cancer.

Cited by 37 publications

References 12 publications

Involvement of delta opioid receptors in alcohol withdrawal-induced mechanical allodynia in male C57BL/6 mice

Involvement of delta opioid receptors in alcohol withdrawal-induced mechanical allodynia in male C57BL/6 mice

Improving Alcohol Withdrawal Outcomes in Acute Care

Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients

Contact Info

Product

Resources

About