Artigo recomendado: Perioperative Approach to Patients With Opioid Abuse and Tolerance

Benjamin Vaghari, Jaime L. Baratta, Kishor Gandhi

Independently Developed by Mcmahon Publishing, Anesthesiology News - June 2013

Substance abuse in the United States is increasing. Most of the rise in illicit drug use has been attributed to marijuana, with the use of heroin remaining relatively stable over the past 10 years. Yet although heroin use has plateaued, overall use of opioid analgesics has increased dramatically. Sales of prescription opioids quadrupled between 1999 and 2010.

Enugh of these substances were prescribed in 2011 to medicate every American adult with a standard dose of 5 mg of hydrocodone every 4 hours for a month. In 2010 alone, 12 million Americans reported nonmedical use of prescription pain killers in the past year. As the use and abuse of opioids increases, the likelihood of an anesthesiologist encountering these patients during clinical practice also will increase.

The anesthetic and analgesic implications of increased opioid use are 2-fold. First, as both illegal and prescription use of opioids increases, anesthesiologists will encounter more patients exhibiting opioid tolerance. Second, as abusers of opioids seek treatment for their addiction, the numbers of patients receiving long-term opioid therapy for their addiction also will increase. Long-term medical therapy for opioid dependende introduces several issues in the management of patients that clinicians must consider when forming an anesthetic and analgesic plan.

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