Jage J
Anaesthesie-Abteilung, Behring-Krankenhaus, Berlin.
Anaesthesist. 1988 Aug;37(8):470-82.
This review is devoted to problems that can arise in analgesia and anesthesia in opiate addicts. The following factors are especially important: psychic disorders, heart, lung, liver and kidney disease, AIDS, and tolerance to opiates. Withdrawal of opiates during the perioperative period has a detrimental effect, and the addicted patient should therefore receive generous premedication. Practical experience in the United States of America has shown that the prophylactic administration of methadone is beneficial and prevents withdrawal symptoms. General anesthesia and regional anesthesia are both possible. It is possible to give opiates during general anesthesia achieved with preparations given by inhalation (isoflurane), but it must be borne in mind that high doses are necessary because of these patients' tolerance levels. When regional anesthesia is used for surgery or for postoperative anesthesia, it is important to observe the neurological contraindications. High doses of opiates can be administered (s.c., i.m., p.o., continuous infusion) for postoperative analgesia in opiate addicts with no fear of respiratory depression, with further analgesic treatment as and when necessary (antidepressants, anti-inflammatory agents, neuroleptics, electroacupuncture). Attention is drawn to clonidine as a particularly good drug for the treatment of opiate withdrawal. Problems encountered with abstinent drug addicts are discussed.
本综述致力于探讨阿片类药物成瘾者在镇痛和麻醉过程中可能出现的问题。以下因素尤为重要：精神障碍、心脏、肺部、肝脏和肾脏疾病、艾滋病以及对阿片类药物的耐受性。围手术期停用阿片类药物会产生有害影响，因此成瘾患者应接受充分的术前用药。美国的实践经验表明，预防性给予美沙酮有益且可预防戒断症状。全身麻醉和区域麻醉均可行。在使用吸入制剂（异氟烷）实现全身麻醉期间可以给予阿片类药物，但必须牢记，由于这些患者的耐受水平，需要高剂量给药。当区域麻醉用于手术或术后麻醉时，遵守神经学禁忌证很重要。对于阿片类药物成瘾者，术后镇痛可给予高剂量阿片类药物（皮下、肌肉注射、口服、持续输注），不用担心呼吸抑制，必要时可进一步进行镇痛治疗（抗抑郁药、抗炎药、抗精神病药、电针）。特别提到可乐定是治疗阿片类药物戒断的一种特别好的药物。文中讨论了戒毒者所遇到的问题。
