This is a state where a loss of sensation and/or loss of consciousness occurs. There are two types of anaesthesia: 1 – Local anaesthesia, where a loss of sensation occurs, and 2. General anaesthesia – where a loss of consciousness occurs if under general anaesthesia. This can be caused by inhalation of aesthetic gas or an injection of an anaesthetic agent.
In the addiction recovery community, anaesthesia refers to a procedure in which medications are administered to help manage withdrawal symptoms and cravings. These medications work by blocking the effects of drugs or alcohol on the brain receptors, thereby reducing the pleasurable sensations associated with substance use.
When alcohol is abruptly discontinued, withdrawal symptoms such as tremors, tachycardia, arrhythmias, hypertension, nausea, vomiting, confusion, agitation, and hallucinations can occur. These symptoms can be mitigated by administering benzodiazepines and alpha-2 adrenergic agonists. Acute alcohol intoxication also raises the risk of pulmonary aspiration.
For those with a history of alcohol abuse, regional anesthesia can be safely used, though care must be taken with patients treated with disulfiram due to the risk of polyneuropathy and the potential for acute hypotension caused by disulfiram’s inhibition of dopamine β-hydroxylase. This requires careful management of intravascular fluid volume before regional anesthesia to prevent hypotension, which might be addressed with ephedrine or more predictably with direct-acting sympathomimetics like phenylephrine in the case of norepinephrine depletion.
In cases requiring general anesthesia, adjustments in the dosing of intravenous induction drugs may be necessary due to associated hepatic dysfunction, hypoalbuminemia, and cardiac failure in chronic alcohol users. Such individuals often exhibit resistance to CNS depressants, and the use of high concentrations of potent inhaled anesthetics could depress cardiovascular function. Additionally, the risk of aspiration increases because of greater gastric fluid volume and acidity, along with diminished laryngeal reflexes.
One commonly used medication for anaesthesia in addiction treatment is naltrexone. It is an opioid receptor antagonist that can be used for both alcohol and opioid dependence. By blocking the receptors, it reduces the rewarding effects of substances, making it less appealing to continue using them.
Another medication used for anaesthesia is disulfiram, primarily for alcohol addiction. Disulfiram works by inhibiting the breakdown of alcohol in the body, leading to the accumulation of a toxic substance called acetaldehyde. This buildup causes unpleasant physical reactions if alcohol is consumed, such as nausea, headache, and flushing. The idea behind disulfiram is to create a strong aversion to drinking by associating it with discomfort.
Anaesthesia can be a useful tool in addiction treatment as it helps individuals adjust to life without the pleasurable effects of substances. It can be particularly helpful during the early stages of recovery when cravings and withdrawal symptoms are strong. However, it is key to note that anaesthesia alone is not a cure for addiction. It should be combined with counselling, therapy, and other support to address the underlying causes and behaviors associated with addiction.
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