Alcohol Before Anesthesia: How it Affects Surgery and Recovery

No amount of alcohol consumption is healthy, but under anesthesia, the ill effects of alcohol can flare up and make things worse. In an interview with Happiest Health, Dr Ravi Kumar IR, consultant anesthesiologist, Milann Fertility & Birthing Hospital, Bangalore shared that alcohol consumption can have both long and short-term effects on a person under the influence of anesthesia. “The immediate effects start to show as changes in the nervous system. But the late effects involve the entire body – nervous system, kidneys, liver, heart, brain and the immune system.”

Explaining the effects, Dr Ravi added, “Most anesthetic drugs administered to a person are metabolized by the kidneys and the liver. But under the effect of alcohol, this metabolism is hampered – this can prolong or shorten the effects of anesthesia. When shortened, more anesthetic drugs are administered which can be harmful; and when prolonged, recovery can be delayed.”

How does alcohol affect anesthesia?

Dr. Abhishek Banerjee, senior consultant, gastrointestinal medical specialist, Manipal Hospital, Broadway, Kolkata, noted down the main effects of alcohol consumption on people on anesthesia administration.

Infection: Dr Banerjee shared that when anesthesia is administered while the person is under the influence of alcohol, there is an increased risk of infection after the surgery.

Bleeding: The risk of bleeding during the surgery also increases if the person does not stop consuming alcohol, at least a few days prior to the operation.

Anesthesia complications: People who consume more than 40 grams of alcohol per day are more likely to require higher doses of anesthetic and analgesic agents. This can lead to more health complications.

Alcohol withdrawal: “A person who consumes alcohol daily above the permissible limit is more likely to develop alcohol withdrawal after the surgery,” said Dr Banerjee. Alcohol withdrawal, also known as delirium tremors, refers to the set of symptoms that develop after a person stops consuming alcohol. The symptoms include headache, irritability, increased heart rate, blood pressure, palpitations, tremors and confusion.

High surgical risk: People with known alcoholic liver disease, including alcoholic hepatitis or alcoholic cirrhosis, are at a high surgical risk irrespective of the nature of surgery.

Precautionary measures to be taken

Doctors share the precautionary measures that must be taken before anesthesia is administered.

Liver function test before surgery: “Elevated levels of enzymes like SGOT, SGPT, bilirubin or GGT can denote alcohol use disorder. It is important to consult a gastroenterologist and screen for alcohol associated liver disease including steatotic liver disease, alcoholic hepatitis or any underlying cirrhosis,” said Dr Banerjee.

Pre-operative counseling: Proper counselling or psychological counselling along with that some kind of pharmacotherapy should be done to make the person abstinent from alcohol consumption.

A week of abstinence: “The best practice is to have at least a week of abstinence. Compared to general anesthesia, regional anesthesia is safer for alcoholics. But in some medical cases of gastrointestinal surgeries, liver surgeries, or liver tract procedures, general anesthesia needs to be administered. In those cases, the person is prepared for de-addiction,” shared Dr Ravi.

Track vital parameters: In case of emergency surgeries, a person might be under the influence of alcohol. In those cases, the vitals are tracked before, during and after the surgery. “Liver function test is done. Echocardiography is also done because alcohol users have a higher risk of arrhythmia – irregular heartbeat with palpitations, chest pain, dizziness and shortness of breath,” said Dr Banerjee.

Anesthetic agents: “The anesthetic agents need to be decided with careful consideration. Being vigilant about postoperative healing, alcohol withdrawal symptoms and cardiac monitoring should be done,” said Dr Banerjee.

How much alcohol is too much alcohol?

Risky alcohol consumption is when a man aged 65 years or less consumes more than 14 drinks a week; and a woman within the age limit of 65 years consumes more than 7 drinks a week. A standard drink contains about 12 grams of alcohol, but depending on the type of alcoholic beverage, the quantity varies,” said Dr Banerjee.

Addressing the gender disparity of how the alcohol threshold is lower in women, Dr Banerjee shared that due to some gastric and other hepatic enzymes, women are more prone to alcohol-related liver diseases than men.

Takeaways

Alcohol consumption before anesthesia administration can lead to many complications and surgical risks. Doctors share precautionary measures to ensure healthy outcomes and faster recovery.