Kliniken für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Curr Opin Anaesthesiol. 2010 Jun;23(3):384-90. doi: 10.1097/ACO.0b013e3283391f79.
One in five patients in the perioperative setting has a alcohol use disorder (AUD), one in three patients has a nicotine use disorder (NUD) and one in 10 patients has a drug use disorder (DUD) with a high risk of dependency. Patients with dependencies challenge physicians with various complications within the perioperative setting.
Adequate treatment of alcohol, nicotine and drug dependency during the perioperative and intraoperative course requires established screening tools in order to evaluate patients' susceptibility to developing complications. Particularly in these patients, secondary prevention and early treatment is warranted.
Alcohol, nicotine and drug dependency are very treatable. Numerous effective therapeutic options are available and should be offered to patients. Intensive care treatment can be shortened or even avoided by initiating preventive measures. A multimodal approach includes implementation of screening tools, motivational interviewing, preoperative abstinence, individual anaesthesiological treatment, stress reduction preventing delirium and postoperative infection, prevention and treatment of withdrawal syndrome, replacement therapies and provision of preoperative or postoperative detoxification. The implementation rate is very low and urgently requires strategies for improvement.
围手术期每 5 名患者中就有 1 名患有酒精使用障碍（AUD），每 3 名患者中就有 1 名患有尼古丁使用障碍（NUD），每 10 名患者中就有 1 名患有药物使用障碍（DUD），且这些患者具有很高的依赖性风险。患有依赖症的患者会在围手术期出现各种并发症，从而给医生带来挑战。
为了评估患者发生并发症的易感性，需要在围手术期和手术过程中使用既定的筛查工具，对酒精、尼古丁和药物依赖进行充分治疗。特别是对于这些患者，需要进行二级预防和早期治疗。
酒精、尼古丁和药物依赖是可以治疗的。有许多有效的治疗方法可供选择，应该向患者提供这些治疗方法。通过采取预防措施，可以缩短重症监护治疗的时间，甚至可以避免治疗。多模式方法包括实施筛查工具、动机访谈、术前戒断、个体化麻醉治疗、减少压力以预防谵妄和术后感染、预防和治疗戒断综合征、替代疗法以及提供术前或术后解毒。但目前这些方法的实施率非常低，迫切需要制定改进策略。
