By Ethan O. Bryson, M.D., and Elizabeth A. M. Frost, M.D. Philadelphia, Lippincott Williams & Wilkins, 2011. Pages: 176. Price: $176.00.
The successful treatment of substance abuse has been challenging addiction medicine specialists for years, while the spectrum of illicit drugs has been increasing. The prevalence of alcoholism or drug addiction is vast, so that most people personally know someone with the disease or have experienced it themselves. Alcoholics and drug addicts commonly present to surgery, sometimes acutely intoxicated, posing a particular challenge to anesthesia clinicians. In addition, anesthesiologists and nurse anesthetists are themselves at risk for becoming addicted to the same medications they administer to patients; a wide path of personal destruction or death can occur unless a recovery program is offered in time.
Anesthesia and Addiction enhances and clarifies current knowledge in this rapidly changing field. The book begins with a chapter on the genetic and cellular mechanisms of addiction, effectively leading to the next chapter on management of substance abuse in the hospital setting. The integration of the scientific basis of addiction and its clinical management is a strength of the presentation throughout the book.
From chapters on anesthetic implications of alcoholism and illicit opioid abuse to chapters on cocaine and the club drugs as well as marijuana and other inhaled toxins, the book covers a wide range of abused substances. Eye-opening statistics are given for each drug of abuse. Pathophysiology and organ dysfunction are detailed, laying the foundation for anesthetic considerations.
Other chapters address specialized topics such as anesthesia for opioid detoxification and drug and alcohol use during pregnancy. Drug abuse in the patient with chronic pain and perioperative implications of buprenorphine maintenance treatment are additional chapter topics. Controversial areas of management are presented thoughtfully and handled fairly. Finally, “The Drug-Seeking Anesthesia Care Provider” chapter sheds new light on the scope of this underestimated problem, which may have an undetected incidence of diversion reaching 8–9%, according to survey data presented in the book. My opinion is that typical signs and symptoms may be inadequate to identify many addicts. Perhaps the focus should be shifted to consulting recovering addicts, who may be willing to identify methods used to divert the drug along with associated in-hospital behaviors.
Anesthesia and Addiction is concise and informative, clearly dividing the material into labeled categories. The book strikes the right balance between being comprehensive yet succinct. Each chapter is supported by helpful tables and an extensive list of references.
As a pioneer textbook of its kind, Anesthesia and Addiction sets a high standard for future endeavors. It is relevant reading for all anesthesia clinicians, whether experienced or intraining. The topics covered are undoubtedly encountered in clinical practice.
Furthermore, institutions could also use the material to formulate diversion prevention programs, a safety initiative to protect our own.