Question 1: “How often did you have a drink containing alcohol in the past 12 months?”
Response (score): never (0), monthly or less (1), 2–4 times a month (2), 2–3 times a week (3), 4 or more a week (4)
Question 2: “How many drinks containing alcohol did you have on a typical day when you were drinking in the past 12 months?”
Response (score): 0 drink (0), 1–2 drinks (0), 3–4 drinks (1), 5–6 drinks (2), 7–9 drinks (3), and 10 or more (4)
Question 3: “How often did you have 6 or more drinks on an occasion in the past 12 months?”
Response (score): never (0), less than monthly (1), monthly (2), weekly (3), and daily (4)
AUDIT-C score is the sum of the points from each question (range 0–12 points)
The use of illicit drugs is associated with pulmonary and cardiac complications that may affect management in the perioperative setting [6]. Identifying patients who abuse illegal drugs can be screened effectively using a single question: “How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?” In an urban primary care setting, this single screening question was 100 % sensitive and 73.5 % specific for the detection of a drug use disorder [7].
An injection drug use history should prompt investigation for infectious or other complications.
Active substance abuse or dependence identified during preoperative evaluation is an indication for referral to primary care and counseling or rehabilitation resources.
Perioperative Management
Patients at risk for withdrawal during preoperative evaluation should have appropriate measures taken in the postoperative setting. Consideration of withdrawal syndromes is part of a full assessment of delirium in the postoperative setting (see Chap. 46). In some cases, patients have undergone emergency surgery and are unable to provide a history—additional information regarding substance use may need to be obtained from other sources. Patients identified with substance abuse or dependence should be referred to appropriate rehabilitation services. Withdrawal management strategies for specific substances are summarized below [8].
Alcohol
Withdrawal Signs and Symptoms
Acute alcohol withdrawal generally starts 6 to 24 h after the patient takes the last drink of alcohol.
Signs and symptoms include: restlessness, agitation, anxiety, nausea, vomiting, tremor, increased blood pressure, hyperthermia, delusions, delirium, and seizures.
Withdrawal Management
Monitoring and treatment use Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar) paired with symptom-triggered use of benzodiazepines [9]
Opioids
Withdrawal Signs and Symptoms
Tachycardia, hypertension, hyperthermia, insomnia, enlarged pupils, diaphoresis, hyperreflexia, increased respiratory rate, abdominal cramps, nausea, vomiting, diarrhea, muscle pain, and anxiety
Withdrawal Management
Consider monitoring and measuring opioid withdrawal using Subjective Opioid Withdrawal Scale (SOWS) and Objective Opioid Withdrawal Scale (OOWS) [10].
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