medigraphic.com

2004, Número 2

<< Anterior Siguiente >>

Rev Mex Anest 2004; 27 (2)


Manejo anestésico del paciente con alcoholismo

Rivera-Flores J, Chavira-Romero M

Idioma: Español
Referencias bibliográficas: 122
Paginas: 97-106
Archivo PDF: 96.32 Kb.


RESUMEN

El etanol es una de las sustancias psicoactivas más empleadas desde épocas antiguas y ha sido relacionada con incremento de la morbilidad y la mortalidad en pacientes que son sometidos a procedimientos de urgencia o electiva, debido a que produce diversas alteraciones en los diferentes órganos y sistemas tanto en intoxicación etílica aguda como crónica; o si se encuentra con el síndrome de supresión; también se ha relacionado directamente con los traumatismos; por lo que muchos pacientes requieren de un manejo anestésico de urgencia. La farmacología de los anestésicos que empleamos se encuentra alterada en ambos tipos de intoxicaciones etílicas (aguda y crónica) principalmente relacionada con el metabolismo de los mismos fármacos; habiéndose señalado que las dosis en los pacientes agudos deben reducirse hasta en un 50%; y que en los crónicos debido a la inducción enzimática por acción del citocromo P450 se incrementan; produciendo una mayor cantidad de metabolitos activos y tóxicos. Debe prevenirse y/o tratarse el síndrome de supresión debido a que se relaciona con incremento de la morbilidad y la mortalidad de los pacientes alcohólicos.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Rivera FJ. Alcohol, trauma y anestesia. Memorias XXIV Curso Actualización en Anestesiología. SMA. 1998:1-5.

  2. Teboul A, Pourriat JL. Anestesia en el alcohólico. En: Enciclopedia Médico-Quirúrgica. Anestesia y Reanimación. Ed. Scientifiques et Médicales Elsevier. París Francia. 2000;36-659-B-10:1-10.

  3. Teboul A, Pourriat JL. Anestesia del paciente alcohólico. En: Enciclopedia Médico-Quirúrgica. Ed. Scientifiques et Médicales Elsevier. París Francia. 2002;E-36-659-B-10:1-8.

  4. Kershenobich S, García PM. El alcohol: adicción y daño hepático. Cuadernos de Nutrición. 1996;19(4):6-14.

  5. Garza EP. Alcoholismo. Rev Fac Med UNAM 1992;35:45-46.

  6. Rivera FJ. Alcoholismo y Anestesia. Anest Méx 1999;11(Supl. 1):125-126.

  7. Yuguero J. Alcoholismo. En: Villegas JF. Tratado de Medicina Práctica. Medicine. 2a Ed. Publicaciones Americanas de México, S.A. de C.V. 1988;45:2904(68-86).

  8. Rivera FJ. Anestesia en el paciente traumatizado con intoxicación etílica. Memorias XXVI Congreso CLASA. San Salvador, El Salvador. 2001:49-51.

  9. Naudé PG. Alcohol y abstinencia aguda. En: Naudé GP, Bongard FS, Oemetriades O. Secretos del traumatismo. 1a Ed. McGraw-Hill Interamericana. 2000:273-76.

  10. Lex BW. Alcohol problems in Special Populations. In: Mendelson JH, Kello NK. Eds. Medical Diagnosis and Treatment of Alcoholism. 1st Ed. McGraw-Hill, Inc. 1992:71-154.

  11. Menorf SB. Alcohol related injuries among adolescents in the EO. Ann Emerg Med 1995;26:180-86.

  12. Williams GD, Stinson FS, Lane JD, et al. Apparent per capita alcohol consumption: national, state and regional trends, 1977 -1994. National Institute on Alcohol Abuse and Alcoholism. 1996:3-6.

  13. Gomberg ESL. Women and alcohol: use and abuse. J Nerv Ment Dis 1993;181:211-19.

  14. Whiteman PJ, Hoffman RS, Goldftank LR. Alcoholism in the Emergency Department: an epidemiologic study. Acad Emerg Med 2000;7:14-20.

  15. Beattie Ch, Lewis TC, Mark LJ. Evaluation of the patient with alcoholism and other drug dependence. Craven L. Ed. In: Principles and Practice of Anesthesiology. Ed. Mosby. 2st Ed. 1998:528-54.

  16. Sistema de Encuestas de Salud: Encuesta Nacional de Adicciones. Secretaría de Salud. Dir. Gral. de Epidemiología. Instituto Mexicano de Psiquiatría 1990;22-24:52-57.

  17. Medina MME, Tapia R, Sepúlveda J y cols. Los patrones de consumo de alcohol y los síntomas de dependencia de la población urbana de la República Mexicana. Anales VI Reunión de Investigación. Instituto Mexicano de Psiquiatría.

  18. Spies CD, Rommelspacher H. Alcohol Withdrawal in the Surgical Patient: Prevention and Treatment. Anesth Analg 1999;88:946-54.

  19. Spies C, Neuner B, Neumann T, et al. Intercurrent complications on chronic alcoholics admitted to the intensive care unit following trauma. Intensive Care Med 1996;22:286-93.

  20. Spies C, Nordmann A, Brummer G, et al. Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract. Acta Anaesthesiol Scand 1996;22:286-93.

  21. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV. 4th Ed. Washington, D.C. American Psychiatric Association, 1991.

  22. Bruce DL. Alcoholism and anesthesia. Anesth Analg 1983;62:84-96.

  23. Pohorecky LA, Shah P. Etanol-induced analgesia. Life Sci 1987;41:1289-95.

  24. Monzini M, Masini E, Gambassi F, Mannaioni PF. Gammahydroxybutiric acid and alcohol-related syndromes. Alcohol; 2000;20:285-91.

  25. Charness ME. Molecular Mechanisms of Etanol Intoxication, Tolerance, and Physical Dependence. In: Mendelson JH, Mello NK. Eds. Medical Diagnosis and Treatment of Alcoholism. Eds. McGraw-Hill, Inc. New York. 1992:155-200.

  26. Melmon K, Morelli H. Clinical Pharmacology. 3rd Ed. McGraw-Hill. New York. 1992:770-77.

  27. Dodd P. Neural mechanisms of adaptation in chronic ethanol exposure and alcoholism. Alcohol Clin Exp Res 1996;20:151A-156A.

  28. Ortiz J, Fitzgerald LW, Charlton M, et al. Biochemical actions of chronic ethanol exposure in the mesolimbic dopamine system. Synapse 1995;21:289-98.

  29. Crews FT, Morrow AL, Criswell H, Breese G, et al. Effects of ethanol on ion channels. Int Rev Neurobiol 1996;39:283-367.

  30. Davies JW, et al. Effect of alcohol on the utility of base deficit in trauma. J Trauma 1997;43:507-10.

  31. Rodríguez MA, Zapata IL. Hepatopatía por alcohol. Rev Med Int Méx 1996;12:105-109.

  32. Goodwin DW. Genetic determinants of alcoholism. In: Mendelson JH, Mello NK. Eds. Medical Diagnosis and Treatment of Alcoholism. Eds. McGraw-Hill, Inc. New York. 1992:55-70.

  33. Lex BW. Alcohol problems in special populations. In: Mendelson JH, Mello NK. Eds. Medical Diagnosis and Treatment of Alcoholism. Eds. McGraw-Hill, Inc. New York. 1992:71-154.

  34. DiPadova C, Womer TM, Julkunen RJK, Lieber CS. Effects offasting and chronic alcohol consumption on the: first-pass metabolism ofethanol. Gastroenterology 1987;92:1169-1173.

  35. Frezza M, DiPadova C, Pozato G, et al. High blood alcohol levels in women: The role of decreased gastric alcohol dehydrogenase activity and: first-pass metabolism. N Engl Med J 1990;322:95-99.

  36. Crabb DW, Bosron WF, Li TK. Ethanol metabolism. Pharmacol Ther 1987;34:59-73 37.

  37. Eckardt MJ, Harford TC, Kaelber CT, et al. J Am Med Assoc 1981;246:648-66.

  38. Bleich HL, Boro ES. Metabolic and hepatic effects of alcohol. N Engl J Med 1977;296:612-16.

  39. Zinn SE, Fairley HB, Glenn M. Liver function in patients with mild alcoholic hepatitis, after enflurane, nitrous oxide-narcotic, and spinal anesthesia. Anesth Analg 1985;64:487–90.

  40. Alderman J, Kato S, Lieber CS. The microsomal etanol oxidizing system mediates metabolic tolerance to ethanol in deermice lacking alcohol dehydrogenase. Arch Biochem Biophys 1989;271:33-39.

  41. Arthur MJP, Lee A, Wright R. Sex differences in the metabolism of ethanol and acetaldehyde in normal subjects. Clin Sci 1984:397-401.

  42. Ehrig T, Bosron WF, Li TK. Alcohol and acetaldehyde dehydrogenase. Alcohol Alcohol 1990;25:105-16.

  43. Goldstein DB. Pharmacokinetics of Alcohol. In: Medical Diagnosis and Treatment of Alcoholism. Mendelson JH, Mellonk. Eds. McGraw-Hill, Inc. 1992:25-54.

  44. Guoh Li. Alcohol and injury severity: Reappraisal of the continuing controversy. J Trauma 1997;42:562-68.

  45. Woodman GE. Acute etanol intoxication and endotoxemia after trauma. J Trauma 1996;41:61-72.

  46. Menorf SB. Alcohol related injuries among adolescents in the ED. Ann Emerg Med 1995;26:180-86.

  47. Waller JA. Management issues for trauma patients with alcohol. J Trauma 1990;30:1548-53.

  48. Thal ER, et al. Effects of alcohol and other drugs on traumatized patients. Arch Surg 1985;120:708-12.

  49. Brickley MR, Shepherd JP. The relationship between alcohol intoxication, injury severity and Glasgow score. Injury 1995;26:311-14.

  50. Freenland E. Alcohol y traumatismos. Clin Urg Norte Am 1993;3:891-917.

  51. Tintinalli JE. Alcohols. Toxicology. In: Tintinalli JE. Emergency Medicine. McGraw-Hill. 1996:765-71.

  52. Jurkovich GJ, Greiser WB, Lutennan A, Curreri PW. Hypothermia in trauma victims: an ominous predictor of survival. J Trauma 1987;27:1019-24.

  53. Chamess ME, Simon RP, Greenberg DA. Alcohol and the nervous system. N Engl J Med 1989;321:442-54.

  54. Victor M. The effects of alcohol on the Nervous System. In: Mendelson JH, Mello NK. Medical Diagnosis and Treatment of Alcoholism. McGraw-Hill, Inc. 1992:201-62.

  55. Perr IN. Pathological intoxication and alcohol idiosyncratic intoxication: I. Diagnostic and clinical aspects. J Forensic Sci 1986;31:806-11.

  56. Lechtenber R, et al. Total ethanol consumption as a seizure risk factor in alcoholics. Acta Neurol Scand 1992;85:90-94.

  57. Agelink MW, Malessa R, Weiser U, et al. Alcoholism, peripheral neuropathy (PNP) and cardiovascular autonomic neuropathy (CAN). J Neurol Sci 1998;161:135-42.

  58. Balnc P, Boussuges A, Von Elrn BE, et al. Insuffisence cardiaque droite par carence en thiamine. Presse Méd 2000;29:1231.

  59. Chamess ME, Simon RP, Greenberg DA. Alcohol and the nervous system. N Engl J Med 1989;321:442-54.

  60. Flack-Yter Y, McCullough AJ. Nutritional effects of alcoholism. Curr Gastroenterol Rep 2000;2:331-36.

  61. Fauchier L, Babuty D, Poret P, Casset-Senon D, et al. Comparison of long-term outcome of alcoholic and idiopathic dilated cardiomyopathy. Eur Heart J 2000;21:306-14.

  62. Little JM. Chronic pancreatitis: results of a protocol of management. Aust N Z J Surg 1983;53:403-9.

  63. Tonnesen H, Kehlet H. Preoperative alcoholism and postoperative morbidity. Br J Surg 1999;86:869-74.

  64. Vidal S, Andrinajatovo JJ, Dubau B, Winnock S, Maurette P. Encéphalopathies postopératoires: la carence in thiamine, une étiologie a ne pas méconnotaitre. Ann Fr Anesth Réanim 2001;20:40-43.

  65. Dannenberg HD, Nahir M, Hasin Y. Acute myocardial infarction due to delirium tremens. Cardiology 1999;92:144.

  66. Schumacher L, Pruitt JN 2”, Phillips M. Identifyng patients “a risk” for alcohol withdrawal syndrome and a treatment protocol. J Nerosci Nurs 2000;32:158-63.

  67. Shorvon S. Tonic-clonic status epilepticus. J Neurol Neurosurg Psychiatry 1993;56:125-34.

  68. Beattie Ch, et al. Evaluation of the patient with alcoholism and other drug dependencies. In: Rogers MC. Ed. Principles and Practice of Anesthesiology. Ed. Mosby. 1993:537-66, 69.

  69. Lieber CS. Medical disorders of alcoholism. N Engl J Med 1995;333:1058-65.

  70. Hall W, Zador D. The alcohol withdrawal syndrome. Lancet 1997;349:1897-900.

  71. Becker HC, Diaz GJL, Weathersby RT. Repeated ethanol withdrawal experience increases the severity and duration of subsequent withdrawal seizures in mice. Alcohol 1997;14:319-26.

  72. Blume SB. Women and alcohol. JAMA 1986;256:1467.

  73. Levy M, Koren G. Efectos obstétricos y neonatales de las drogas. Clin Med Urg Norte Am 1990;3:727-50.

  74. Hannigan JH, Welch RA, Sokol RJ. In: Mendelson JH, Mello NK. Eds. Recognition of fetal alcohol syndrome and alcohol-related birth defects. In: Medical Diagnosis and Treatment of Alcoholism. McGraw-Hill, Inc. Ed. 1992:639-68.

  75. Rivera FJ, Campos VAF. Anestesia en paciente embarazada farmacodependiente. En: Canto Sánchez L. Anestesia Obstétrica. Vázquez Moctezuma I, Aldrete Velasco J. Eds. Manual Moderno. 2001:597-612.

  76. Stromland K. Ocular abnormalities in the fetal alcohol syndrome. Acta Ophtalmol 1985;171(Suppl):63.

  77. Abel EL, Sokol RJ. A revised conservative estimate of the incidence of FAS and its economic impact. Alcoholism: Clin Exp Res 1991;15:514-24.

  78. Schroder W, Vogelsang H, Bartels H, Luppa P, Bush R, Holsher AH. Carbohydrate-deficient transferring (CDT) as preoperative alcohol marker in surgical risk patient. Chirurg 1998;69:72-76.

  79. Soyka M, Bondy B, Benda E, Preuss U, Hegerl U, Moller H. Platelet monoamine oxidase activity in alcoholics with and without family history of alcoholism. Eur Addjct Res 2000;6:57-63.

  80. Soderstrom CA, et al. Predictive mode to identify trauma patients with blood alcohol concentrations. J Trauma 1997;42:67-73.

  81. Spies CD. Relevance of carbohydrate deficient transferrina. J Trauma 1995;39:742-48.

  82. Shosting J, et al. Screening for alcohol and drug abuses. Med Clin Norte Am 1997;81:845-60.

  83. Brickley MR, Shepherd JP. The relationship between alcohol intoxication, injury severity and Glasgow score. Injury 1995;26:311-14.

  84. Capítulo V. De las normas aplicables relativas al consumo de bebidas alcohólicas, enervantes, estupefacientes y sustancias psicotrópicas o tóxicas. Arts. 99 y 100. Reglamento de Tránsito para el D.F. Ed. SIST A. 2003:48-49.

  85. Skinner HA, Hold S, Schuller R, et al. Identification of alcohol abuse using laboratory tests and a history of trauma. Ann Intern Med 1984;101:487.

  86. Sillanauke P. Laboratory markers of alcohol abuse. Alcohol Alcohol 1996;31:613-6.

  87. Stibler H. Carbohydrate-deficient transferrin in serum: a new marker of harmful alcohol consumption reviewed. Clin Chem 1991;37:2029-37.

  88. Veit AM, Fitzpatrick. Alcoholismo. En: Duke J, Rosenberg SG. Secretos de la Anestesia. McGraw-Hill Interamericana. México, D.F. 1997:407-14.

  89. Kersenobich D. El alcoholismo como problema médico. Rev Fac Med 1992;35(2).

  90. Ewing JA. Detecting alcoholism: the CAGE Questionnaire. JAMA 1984;252:1905-7.

  91. Ganry O, Joly JP, Stan-Quintin I, Queval M, Beaudot JM, Dubreuil A. Alcohol use disorders in French university hospital patients. Eur Addict Res 2000;6:91-96.

  92. Spandorfer JM, Israel Y, Tuerner BJ. Primary care physicians’ views on screening and management of alcohol abuse: inconsistencies with national guidelines. J Fam Pract 1999;48:899-902.

  93. Frost EAM, Seidel MR. Valoración preanestésica del paciente con abuso de drogas. Clin Anest Norte Am 1990;4:781-94.

  94. Farré M, Salvá P. Interacciones de fármacos y alcohol. Medicine 1987;42:2614-18.

  95. Newrnan LM, Curran MA, Becker GL. Chronic alcoholism attenuates the anesthetic effects of diazepam. Anesthesiology 1984;61:A39.

  96. Newrnan LM, Curran MA, Becker GL. Effects of chronic alcohol intake on anesthetic responses to diazepam and thiopental in rats. Anesthesiology 1986:196-200.

  97. Trouvin JH, Farinotti R, Habeer JP, Servin F, Chauvin M, Duvaldestin P. Pharmacokinetics of midazolam in anaesthetized cirrhotic patients. Br J Anaesth 1988;60:762-67.

  98. Haberer JP, Schoeffler P, Couderc E, Duvaldestin P. Fentanyl pharmacokinetics in anaesthetized patients with cirrosis. Br J Anaesth 1982;54:1267-1270.

  99. Spies C, Dubisz N, Funk W, et al. Prophylaxis of alcohol withdrawal syndrome in alcohol dependent patients admitted to the intensive care unit following tumor resection. Br J Anaesth 1995;75:734-9.

  100. Herve C, Gaillard M, Roujas F, Huguenard P. Alcoholism in polytrauma. J Trauma 1986;26:1123-6.

  101. Edwards R, Mosher VB. Alcohol abuse, anaesthesia, and intensive care. Anaesthesia 1980;35:474-89.

  102. Couderc E, Ferrier C, Haberer JP, Henzel D, Duvaldestein P. Thiopentone pharmacokinetics in patients with alcoholism chronic. Br J Anaesth 1984;56:1393-97.

  103. Fassoulaki A, Farinotti R, Servin F, Desmonts JM. Chronic alcoholism increases the induction dose of propofol in humans. Anesth Analg 1993;77:553-56.

  104. May JA, White HC, Leonard-White A, Warltier DC, Pagel PS. The patient recovering from alcohol or drug addiction: special issues for the anesthesiologist. Anesth Analg 2001;92:1601-8.

  105. O’Daniel L. Anesthetic management of the alcoholic patient. AANAJ 1980;48:445-51.

  106. Bukusoglu C, Thalhammer JG, Krieger NR. Analgesia with anesthetic steroids and ethanol. Anesth Analg 1993;77:27-31.

  107. 107 Boyadjieva N, Sarkar DK. Effects of chronic alcohol on beta-endorphin secretion from hypothalamic neurons in primary cultures: evidence for alcohol tolerance, withdrawal, and sensitization responses. Alcohol Clin Exp Res 1994;18:1497-501.

  108. Shah S, Duttaroy A, Sehba F, Chen B, Philippe J, Monderson T, et al. The effects of ethanol drinking on opioid analgesia and receptors in mice. Alcohol 1997;14:361-66.

  109. Haberer JP, Shoeffler P, Couderc E, Duvaldestein P. Fentanyl Pharmacokinetics in anaesthetized patients with cirrhosis. Br J Anaesth 1982;54:1267-70.

  110. Bell RL, Olson RD, Vaccarino AL. Tolerance to ethanol analgesia is not accompanied by cross-tolerance to morphine analgesia in rats. Pharmacol Biochem Behav 1998;59:123-27.

  111. Duvaldestein P, Lebrault C, Chauvin M. Pharmacokinetics of muscle relaxants in patients with liver disease. Clin Anesthesiol 1985;3:293-306.

  112. Fassoulaki A, Drasner K, Eger El 2°. Is chronic ethanol consumption associated with tolerance to intrathecallidocaine in the rat? Anesth Analg 1990;70:489-92.

  113. Fiset L, Leroux B, Rothen M, Prall C, Zhu C, Ramsay DS. Pain control in recovering alcoholics: effects of local anesthesia. J Stud Alcohol 1997;58:291-96.

  114. Lynch EP, Lazor MA, Gellis ME, Orav J, Goldman L, Marcantonio ER. The impact of postoperative pain on the development of postoperative delirium. Anesth Analg 1998;86:781-85.

  115. Lineaweaver WC, Anderson K, Hing DN. Massive doses of midazolam infusion for delirium tremens without respiratory depression. Crit Care Med 1988;16:294-95.

  116. McCowan C, Marik P. Refractory delirium tremens treated with propofol: a case series. Crit Care Med 2000;28:1781-84.

  117. Moncini M, Masini E, Gambassi F, Mannaioni PF. Gamma-hidroxibutyric acid and alcohol-related syndromes. Alcohol 2000;20:285-91.

  118. Myrick H, Brady KT, Malcolm R. Divalproex in the treatment of alcohol withdrawal. Am J Drug Alcohol Abuse. 2000;26:155-60.

  119. Rommelspacher H. Alcohol Withdrawal in the surgical patient: Prevention and Treatment. Anesth Analg 1999;88:946-54.

  120. Way LW. Current Surgical Diagnosis and Treatment. 10th Ed. Norwalk, CT. Appleton & Lange. 1994.

  121. Riihioja P, Jaatinen P, et al. Dexmedetomidine alleviates etanol withdrawal symptoms in the rat. Alcohol 1997;14:537-44.

  122. Riihioja P, Jaatinen P, et al. Effects of dexmedetomidine on rat locus coeruleus and ethanol withdrawal symptoms during intermittent ethanol exposure. Alcohol Clin Exp Res 1999;23:432-8.




2020     |     www.medigraphic.com