The Patient Recovering from Alcohol or Drug Addiction: Special Issues for the Anesthesiologist

May, Judith A.; White, Herbert; Leonard-White, Ardis; Warltier, David C.; Pagel, Paul S.

doi:10.1097/00000539-200106000-00050

Cited by 51 publications

(31 citation statements)

References 56 publications

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“…[4][5][6][7][8] Chronic liver disease, poor nutrition, and decreased intravascular volume can lead to altered pharmacokinetics of sedatives and analgesics. Pre-ED use of opioids can predispose patients to respiratory depression during PSA, especially when combined with further sedatives.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Long-standing substance misuse may sensitize patients to various anesthetic agents. 7,8 Peripheral intravenous access may be difficult 9 and pain tolerance may be decreased, requiring altered doses of analgesia. 10,11 We compared dosing of sedative and analgesic medications, adverse event (AE) rates, and recovery times in IDUs and non-IDUs undergoing PSA for incision and drainage of cutaneous abscesses.…”

Section: Ré Sumémentioning

confidence: 99%

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Do injection drug users have more adverse events during procedural sedation and analgesia for incision and drainage of cutaneous abscesses?

Scheuermeyer

Andolfatto

Lange

et al. 2013

CJEM

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Objective: Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) in the emergency department (ED). We compared adverse events (AEs) for IDUs to those for non-IDUs receiving PSA for incision and drainage of cutaneous abscesses. Methods: This was a retrospective analysis of a PSA safety audit. IDU status was prospectively documented among consecutive patients undergoing PSA at two urban EDs. Structured data describing comorbidities, vital signs, sedation regimens, and adverse events were collected. Primary outcome was the proportion of patients in each group experiencing an AE, whereas the secondary outcomes included recovery times. Results: Of 525 consecutive patients receiving PSA for incision and drainage of an abscess, 244 were deemed IDUs and 281 non-IDUs. IDUs received higher doses of sedatives and analgesics, and 14 experienced AEs (5.7%), whereas 10 non-IDUs had AEs (3.6%), for a risk difference of 2.1% (95% CI 21.8, 6.5). Median recovery times were 18 minutes (interquartile range [IQR] 10-36) for IDUs and 12 minutes (IQR 7-19) for non-IDUs, for a difference of 6 minutes (95% CI 2-9 minutes). Median sedation times were also longer in IDUs, for a difference of 6 minutes (95% CI 5-10 minutes). Of 20 IDU patients and 1 non-IDU patient admitted to hospital, none had experienced an AE related to PSA. Conclusions: For ED patients requiring PSA for incision and drainage, IDUs had an AE rate similar to that of non-IDUs but longer sedation and recovery times. In experienced hands, PSA may be as safe in IDUs as in patients who do not use injection drugs. RÉ SUMÉObjectif: Les utilisateurs de drogues injectables (UDI) subissent souvent des interventions sous sé dation-analgé sie (SA) aux services des urgences (SU). L'é tude visait à comparer les é vé nements indé sirables (EI) de la SA chez les UDI avec ceux observé s chez les non-UDI, pour l'incision et le drainage d'abcè s cutané s. Mé thode: Il s'agit d'une analyse ré trospective d'une vé rification sur l'innocuité de la SA. La situation d'UDI a é té é tablie de maniè re prospective parmi des patients consé cutifs ayant subi une SA dans deux SU urbains, et il y a eu collecte de donné es structuré es sur les affections concomitantes, les signes vitaux, la posologie des sé datifs administré s, et les é vé nements indé sirables. Le principal critè re d'é valuation é tait la proportion de patients dans chaque groupe qui avait é prouvé des EI, et les critè res d'é valuation secondaires comprenaient, entre autres, le temps de ré veil. Ré sultats: Sur 525 patients consé cutifs, ayant subi une SA pour l'incision et le drainage d'un abcè s, 244 é taient considé ré s comme des UDI et 281, comme des non-UDI. Les UDI ont reç u des doses plus fortes de sé datifs et d'analgé siques, et 14 ont é prouvé des EI (5.7 %), tandis que 10 non-UDI ont connu des EI (3.6 %), soit une diffé rence de risques de 2.1 % (IC à 95 % 21.8, 6.5). Pour ce qui est du temps mé dian de ré veil, celui-ci é tait de 18 minutes (intervalle interquartile [II]: 10-36) chez...

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Section: Discussionmentioning

confidence: 99%

Section: Ré Sumémentioning

confidence: 99%

Do injection drug users have more adverse events during procedural sedation and analgesia for incision and drainage of cutaneous abscesses?

Scheuermeyer

Andolfatto

Lange

et al. 2013

CJEM

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“…However, IDUs may have different physiology than non-IDUs. Patients with chronic substance misuse may be sensitive to anesthetic agents 8,9 ; furthermore, pain tolerance may be decreased, requiring increased analgesia. [10][11][12] When comparing IDUs to non-IDUs, they are felt to have different tolerances for sedative and analgesic medications.…”

Section: Ré Sumémentioning

confidence: 99%

Does the sedation regimen affect adverse events during procedural sedation and analgesia in injection drug users?

Scheuermeyer¹,

Andolfatto²,

Qian³

et al. 2013

CJEM

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Objectives: Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) as part of emergency department (ED) treatment. We compared adverse events (AEs) using a variety of sedation regimens. Methods: This was a retrospective analysis of a PSA safety audit in two urban EDs. Consecutive self-reported IDUs were identified, and structured data describing comorbidities, vital signs, sedation regimens (propofol [P], propofol-fentanyl [PF], fentanyl-midazolam [FM], ketofol [1:1 ketamine:propofol, KF], and ketamine-propofol [KP]) and AEs were collected. The primary outcome was the proportion of patients in each sedation group having an AE; the secondary outcome was the proportion of patients having a cardiovascular or respiratory AE. Results: Data were collected on 276 IDUs (78 P, 82 PF, 65 FM, 25 KF, and 26 KP), and 18 patients had AEs (6.5%, 95% CI 4.0-10.3). The AE rates were 0.0%, 8.5%, 9.2%, 12.0%, and 7.6%, respectively, with propofol having a significantly lower rate (Pearson coefficient 14.9, p 5 0.007). The cardiovascular/ respiratory AE rates were significantly different as well, with P, KP, and KF having the lowest rates (Pearson coefficient 13.3, p 5 0.01). Conclusions: For IDU PSA, the overall AE rate was 6.5%, and propofol appeared to have a significantly lower rate. RÉ SUMÉObjectif: Les utilisateurs de drogues injectables (UDI) subissent souvent des interventions sous sé dation-analgé sie (SA) aux services des urgences. L'é tude visait à comparer la fré quence des é vé nements indé sirables (EI) lié s à la SA, administré e selon diffé rents sché mas posologiques. Le principal critè re d'é valuation é tait la proportion de patients dans chaque groupe de sé dation qui avait connu des EI; le critè re d'é valuation secondaire consistait en la proportion de patients qui avait subi des EI respiratoires ou cardiovasculaires. Ré sultats: Il y a eu collecte de donné es sur 276 UDI (78 P, 82 PF, 65 FM, 25 KF, et 26 KP), et 18 patients ont connu des EI (6.5%; IC à 95% 4.0-10.3). Les taux d'EI se sont é tablis comme suit: 0.0%, 8.5%, 9.2%, 12.0%, et 7.6%, respectivement; un taux significativement plus faible a é té enregistré dans le groupe P (coefficient de corré lation de Pearson 14.9; p 5 0.007). Les taux d'EI respiratoires ou cardiovasculaires variaient considé rablement aussi; les sché mas P, KP, et KF ont obtenu les taux les plus faibles (coefficient de corré lation de Pearson 13.3; p 5 0.01). Conclusions: Le taux global d'EI lié s à la SA chez les UDI s'é levait à 6.5%, et le sché ma P a semblé obtenir un taux sensiblement plus faible que les autres.

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“…29,30 Whenever possible a history pertaining to dose, frequency of ingestion, time of last dose and in the MMT patient, level of stability (as indicated by take-home dose level), should be obtained. This information will help in the assessment of opioid tolerance.…”

Section: Drug-drug Interactionmentioning

confidence: 99%

“…29 The exception to this would be the case where the patient's regular MMT dose of methadone has been interrupted for five or more days. 32 In these cases, the patient should be restarted on methadone by a practitioner knowledgeable in MMT induction, since there may be a marked change in methadone tolerance as a result of this period of methadone abstinence.…”

Section: Postoperative Pain Managementmentioning

confidence: 99%

Review article: Perioperative pain management of patients on methadone therapy

Peng

Tumber

Gourlay

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Methadone, an opioid traditionally associated with the management of opioid addictive disorders, has been prescribed increasingly as an analgesic for the management of various chronic pain conditions. Despite the increasing popularity of methadone, most anesthesiologists are not familiar with its complex pharmacology. The purpose of this article is to review the pharmacology of methadone and to suggest a management algorithm for the perioperative care of methadone patients.S So ou ur rc ce e: : A Medline search was performed to obtain the published literature on the pharmacology of methadone and its use perioperatively.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The complexity of methadone's pharmacology is characterized by a high inter-individual variability, a potential for interaction with other medications, and a long elimination half-life. The postoperative management of methadone patients may be difficult as they are often 'opioid-tolerant' but may be 'pain-intolerant'. For those patients who are taking part in methadone-maintenance programs, there is a potential for the problematic use of opioids or other substances. The management plan for patients taking methadone may differ depending on the type of surgery and the associated perioperative differences in fasting status and gastrointestinal function. In consideration of all the factors listed above, a management algorithm is outlined for the perioperative care of methadone patients.C Co on nc cl lu us si io on n: : Methadone is an opioid with complex properties, and a patient that is taking methadone can represent a unique challenge to the anesthesiologist. A good understanding of the pharmacology of methadone and of the type of patients on this medication will help to improve their perioperative care. Objectif

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The Patient Recovering from Alcohol or Drug Addiction: Special Issues for the Anesthesiologist

Cited by 51 publications

References 56 publications

Do injection drug users have more adverse events during procedural sedation and analgesia for incision and drainage of cutaneous abscesses?

Do injection drug users have more adverse events during procedural sedation and analgesia for incision and drainage of cutaneous abscesses?

Does the sedation regimen affect adverse events during procedural sedation and analgesia in injection drug users?

Review article: Perioperative pain management of patients on methadone therapy

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