Preoperative Evaluation of Chronic Alcoholics Assessed for Surgery of the Upper Digestive Tract

Martin, Michael; Heymann, Christian von; Neumann, Tim; Schmidt, Loren; Soost, F.; Mazurek, Birgit; B??hm, B.; Marks, Christian; Helling, Kai; Lenzenhuber, Erika; M??ller, C.; Kox, Wolfgang J.; Spies, Claudia

doi:10.1097/00000374-200206000-00013

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…The low prevalence of high-risk patients in these three studies is in contrast to a cohort of 705 esophageal cancer patients in Germany, where 64% were CAGE-positive. 22 …”

Section: Resultsmentioning

confidence: 99%

Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review

Carmichael

Morgan

Fabbro

2016

SAR

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BackgroundThe misuse and abuse of opioid medications in many developed nations is a health crisis, leading to increased health-system utilization, emergency department visits, and overdose deaths. There are also increasing concerns about opioid abuse and diversion in patients with cancer, even at the end of life.AimsTo evaluate the current literature on opioid misuse and abuse, and more specifically the identification and assessment of opioid-abuse risk in patients with cancer. Our secondary aim is to offer the most current evidence of best clinical practice and suggest future directions for research.Materials and methodsOur integrative review included a literature search using the key terms “identification and assessment of opioid abuse in cancer”, “advanced cancer and opioid abuse”, “hospice and opioid abuse”, and “palliative care and opioid abuse”. PubMed, PsycInfo, and Embase were supplemented by a manual search.ResultsWe found 691 articles and eliminated 657, because they were predominantly non cancer populations or specifically excluded cancer patients. A total of 34 articles met our criteria, including case studies, case series, retrospective observational studies, and narrative reviews. The studies were categorized into screening questionnaires for opioid abuse or alcohol, urine drug screens to identify opioid misuse or abuse, prescription drug-monitoring programs, and the use of universal precautions.ConclusionScreening questionnaires and urine drug screens indicated at least one in five patients with cancer may be at risk of opioid-use disorder. Several studies demonstrated associations between high-risk patients and clinical outcomes, such as aberrant behavior, prolonged opioid use, higher morphine-equivalent daily dose, greater health care utilization, and symptom burden.

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“…The low prevalence of high-risk patients in these three studies is in contrast to a cohort of 705 esophageal cancer patients in Germany, where 64% were CAGE-positive. 22 …”

Section: Resultsmentioning

confidence: 99%

Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review

Carmichael

Morgan

Fabbro

2016

SAR

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“…However, in cases where information on recent alcohol consumption is unavailable or considered unreliable, markers of alcohol consumption can increase the accuracy of the clinical diagnosis (Bråthen et al. , 2000; Martin et al. , 2002).…”

Section: Resultsmentioning

confidence: 99%

EFNS guideline on the diagnosis and management of alcohol‐related seizures: report of an EFNS task force

Bråthen

Ben‐Menachem

Brodtkorb

et al. 2005

Euro J of Neurology

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Despite being a considerable problem in neurological practice and responsible for onethird of seizure-related admissions, there is little consensus as to the optimal investigation and management of alcohol-related seizures. The final literature search was undertaken in September 2004. Consensus recommendations are given graded according to the EFNS guidance regulations. To support the history taking, use of a structured questionnaire is recommended. When the drinking history is inconclusive, elevated values of carbohydrate-deficient transferrin and/or gammaglutamyl transferase can support a clinical suspicion. A first epileptic seizure should prompt neuroimaging (CT or MRI). Before starting any carbohydrate containing fluids or food, patients presenting with suspected alcohol overuse should be given prophylactic thiamine parenterally. After an alcohol withdrawal seizure (AWS), the patient should be observed in hospital for at least 24 h and the severity of withdrawal symptoms needs to be followed. For patients with no history of withdrawal seizures and mild to moderate withdrawal symptoms, routine seizure preventive treatment is not necessary. Generally, benzodiazepines are efficacious and safe for primary and secondary seizure prevention; diazepam or, if available, lorazepam, is recommended. The efficacy of other drugs is insufficiently documented. Concerning long-term recommendations for non-alcohol dependant patients with partial epilepsy and controlled seizures, small amounts of alcohol may be safe. Alcohol-related seizures require particular attention both in the diagnostic work-up and treatment. Benzodiazepines should be chosen for the treatment and prevention of recurrent AWS.

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“…In fact, they may have higher rates of some of the risk factors (such as smoking) than the general population. Alcoholism is also thought to be more prevalent among cancer patients, although it is not always diagnosed (Bruera et al, 1995 ; Martin et al, 2002 ; Del Fabbro, 2014 ).…”

Section: Risk Factors For Opioid Abuse In Cancer Patientsmentioning

confidence: 99%

A Guide for Pain Management in Low and Middle Income Communities. Managing the Risk of Opioid Abuse in Patients with Cancer Pain

Pergolizzi¹,

Zampogna

Taylor

et al. 2016

Front. Pharmacol.

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Most patients who present with cancer have advanced disease and often suffer moderate to severe pain. Opioid therapy can be safe and effective for use in cancer patients with pain, but there are rightful concerns about inappropriate opioid use even in the cancer population. Since cancer patients live longer than ever before in history (and survivors may have long exposure times to opioid therapy), opioid misuse among cancer patients is an important topic worthy of deeper investigation. Cancer patients with pain must be evaluated for risk factors for potential opioid misuse and aberrant drug-taking behaviors assessed. A variety of validated screening tools should be used. Of particular importance is the fact that pain in cancer patients changes frequently, whether it is related to their underlying disease (progression or remission), pain related to treatment (such as painful chemotherapy-induced peripheral neuropathy), and concomitant pain unrelated to cancer (such as osteoarthritis, headache, or back pain). Fortunately, clinicians can use universal precautions to help reduce the risk of opioid misuse while still assuring that cancer patients get the pain therapy they need. Another important new “tool” in this regard is the emergence of abuse-deterrent opioid formulations.

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Preoperative Evaluation of Chronic Alcoholics Assessed for Surgery of the Upper Digestive Tract

Abstract: To detect more alcoholic patients at risk for major complications, patients should be seen more often, and additional diagnostic tools such as the CAGE, CDT, and GGT should be used before surgery.

Cited by 6 publications

References 23 publications

Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review

Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review

EFNS guideline on the diagnosis and management of alcohol‐related seizures: report of an EFNS task force

A Guide for Pain Management in Low and Middle Income Communities. Managing the Risk of Opioid Abuse in Patients with Cancer Pain

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