Alcohol withdrawal syndrome: Current management strategies for the surgery patient

Introduction and Aim: Management strategies of Alcohol Withdrawal Syndrome could be optimized if patients with greater risk are identified early and treated aggressively. Studying the pattern and predictors of alcohol withdrawal syndrome was the main objective of our study. Materials and Methods: A total of 100 consenting male patients in the age group of 18-60 years diagnosed with alcohol dependence and uncomplicated alcohol withdrawal undergoing in-patient detoxification in tertiary care center in north India were included in the study. A semi structured proforma was used to collect socio-demographic data, Alcohol Use Disorders Identification Test (AUDIT) was used as screening tool and Clinical Institute Withdrawal Assessmentfor Alcohol-revised (CIWA- Ar) was used to assess severity of withdrawal. Results: Symptoms like difficulty in orientation, seizures and hallucinations were relatively specific for severe AWS, while tremors and anxiety were common to all the patients and were non-specific for predicting severity of AWS. The severity of AWS symptoms correlated significantly with increasing age, duration of alcohol use and AUDIT score. Conclusion:We concluded that increasing age, longer duration of alcohol use, higher AUDIT score and symptoms related to hallucinations, orientation and seizure are linked to severe alcohol withdrawal. Prior knowledge of these predictors will help to identify the patients at risk of severe alcohol withdrawal so that individual care can be enhanced.

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Treatment of the Acute Alcohol-Withdrawal Syndrome

Quarterly Journal of Studies on Alcohol ◽

10.15288/qjsa.1958.19.118 ◽

1958 ◽

Vol 19 (1) ◽

pp. 118-124 ◽

Cited By ~ 4

Author(s):

Lincoln Godfrey ◽

Martin D. Kissen ◽

Thomas M. Downs

Keyword(s):

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome

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Evaluation of the course and treatment of Alcohol Withdrawal Syndrome with the Clinical Institute Withdrawal Assessment for Alcohol – Revised: A systematic review-based meta-analysis

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2021.108536 ◽

2021 ◽

Vol 220 ◽

pp. 108536 ◽

Cited By ~ 1

Author(s):

Ildikó Katalin Pribék ◽

Ildikó Kovács ◽

Bettina Kata Kádár ◽

Csenge Sára Kovács ◽

Mara J. Richman ◽

...

Keyword(s):

Systematic Review ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Meta Analysis ◽

Alcohol Withdrawal Syndrome

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Implementation of the Modified Minnesota Detoxification Scale (mMINDS) for Alcohol Withdrawal Syndrome in Critically Ill Patients

The Joint Commission Journal on Quality and Patient Safety ◽

10.1016/j.jcjq.2020.08.006 ◽

2020 ◽

Vol 46 (11) ◽

pp. 656-658

Author(s):

Rachel M. Smith ◽

Brian Benzio ◽

Andrew L. Hendrickson ◽

Evan D. Telford ◽

Andrew J. Franck

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome

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Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00226-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tessa L. Steel ◽

Shewit P. Giovanni ◽

Sarah C. Katsandres ◽

Shawn M. Cohen ◽

Kevin B. Stephenson ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome ◽

Patient Characteristics ◽

Response To Treatment ◽

Alternative Measure ◽

Icu Patients ◽

Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

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