Department of Anesthesiology, Yale University School of Medicine, 333, Cedar Street, New Haven, CT, 06520, USA.
Department of Anesthesiology, LSU School of Medicine, 1542 Tulane Avenue Room 659, New Orleans, LA, 70112, USA.
Curr Pain Headache Rep. 2023 May;27(5):65-79. doi: 10.1007/s11916-023-01108-3. Epub 2023 Apr 20.
Even prior to the COVID-19 pandemic, rates of ambulatory surgeries and ambulatory patients presenting with substance use disorder were increasing, and the end of lockdown has further catalyzed the increasing rates of ambulatory patients presenting for surgery with substance use disorder (SUD). Certain subspecialty groups of ambulatory procedures have already established protocols to optimize early recovery after surgery (ERAS), and these groups have subsequently enjoyed improved efficiency and reduced adverse outcomes as a result. In this present investigation, we review the literature as it relates to substance use disorder patients, with a particular focus on pharmacokinetic and pharmacodynamic profiles, and their resulting impact on the acute- or chronic user ambulatory patient. The systematic literature review findings are organized and summarized. We conclude by identifying areas of opportunity for further study, specifically with the aim of developing a dedicated ERAS protocol for substance use disorder patients in the ambulatory surgery setting. - Healthcare in the USA has seen an increase in rates of both substance use disorder patients and separately in ambulatory surgery cases. - Specific perioperative protocols to optimize outcomes for patients who suffer from substance use disorder have been described in recent years. - Agents of interest like opioids, cannabis, and amphetamines are the top three most abused substances in North America. - A protocol and recommend further work should be done to integrate with concrete clinical data, in which strategies should be employed to confer benefits to patient outcomes and hospital quality metrics like those enjoyed by ERAS protocol in other settings.
即使在 COVID-19 大流行之前，门诊手术和出现物质使用障碍的门诊患者的比例也在增加，而封锁的结束进一步加速了出现物质使用障碍（SUD）的门诊患者接受手术的比例的增加。某些门诊手术的亚专业群体已经制定了优化手术后早期恢复（ERAS）的方案，这些群体因此提高了效率并减少了不良后果。在本研究中，我们回顾了与物质使用障碍患者相关的文献，特别关注药代动力学和药效学特征及其对急性或慢性使用药物的门诊患者的影响。系统文献综述结果进行了整理和总结。最后，我们确定了进一步研究的机会领域，特别是旨在为门诊手术环境中的物质使用障碍患者制定专门的 ERAS 方案。 - 美国的医疗保健机构中，物质使用障碍患者和门诊手术病例的数量都有所增加。 - 近年来，已经描述了针对物质使用障碍患者优化治疗结果的特定围手术期方案。 - 像阿片类药物、大麻和安非他命这样的受关注药物是北美地区滥用最多的三种药物。 - 应该制定一个方案，并进一步开展工作，将其与具体的临床数据相结合，在该方案中，应该采用策略，为患者的治疗结果和医院质量指标（如其他环境中 ERAS 方案所享有的）带来益处。
