Anest. intenziv. Med. 2026;37(3):149-155 | DOI: 10.36290/aim.2026.023

Perioperative management of patients with sedative addictive substance abuseReview Article

Dostálová V. ORCID...1, 3, Kulda K. ORCID...1, Kulhánková J. ORCID...1, Mikl J. ORCID...1, Gabrhelík T. ORCID...2
1 Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové
2 Anesteziologicko­‑resuscitační oddělení, Krajská nemocnice T. Bati, Zlín, Lékařská fakulta Univerzity Palackého v Olomouci
3 Fakulta zdravotnických studií Univerzity Pardubice

Sedative addictive substances represent a significant clinical problem in perioperative care because they affect both the pharmacodynamics and pharmacokinetics of anesthetics and increase the risk of complications during anesthesia. The most commonly abused substances in this group include benzodiazepines, opioids, and alcohol. Their chronic use leads to the development of tolerance, changes in receptor sensitivity, and potential withdrawal syndrome, which can complicate the induction of anesthesia, maintenance of anesthetic depth, and postoperative analgesia. Acute intoxication, on the other hand, potentiates the effects of anesthetics, increasing the risk of respiratory depression, hypotension, and delayed awakening. The aim of this work is to summarize the pharmacological properties of the most commonly abused sedative substances, describe their interactions with anesthetics, and highlight the specifics of perioperative management of patients using them. Proper identification of risks and individualization of the anesthetic plan are key to minimizing complications and ensuring safe anesthetic care.

Keywords: abuse, sedatives, benzodiazepines, opioids, alcohol, anesthesia.

Received: May 19, 2026; Revised: June 9, 2026; Accepted: June 29, 2026; Prepublished online: October 7, 2026; Published: October 14, 2026  Show citation

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Dostálová V, Kulda K, Kulhánková J, Mikl J, Gabrhelík T. Perioperative management of patients with sedative addictive substance abuse. Anest. intenziv. Med. 2026;37(3):149-155. doi: 10.36290/aim.2026.023.
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    References

    1. Polidar P. Problematika lékových závislostí v ordinaci neurologa. Neurol. praxi. 2022;23(6):463-467. doi: 10.36290/neu.2022.001. Go to original source...
    2. Busto UE, Sykora K, Sellers EM. A clinical scale to assess benzodiazepine withdrawal. Journal of Clinical Psychopharmacology. 1989;9(6):412-416. Go to original source...
    3. Kubová K, Franc A, Vysloužil J, Šaloun J, Vetchý D. Nový přístup k detoxikaci pacientů závislých na benzodiazepinech a Z-lécích pro snížení psychogenních komplikací. Čes. slov. farm. 2019;68(4):139-147. doi: 10.36290/csf.2019.016. Go to original source...
    4. Medical Algorithms Company. The Benzodiazepine Withdrawal Scale (CIWA‑B). MedicalAlgorithms.com; 2026. [Internet]. Available from: https://www.medicalalgorithms.com/the-benzodiazepine-withdrawal-scale-ciwa-b.
    5. Pergolizzi JV Jr, Raffa RB, Rosenblatt MH. Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: Current understanding and approaches to management. J Clin Pharm Ther. 2020 Oct;45(5):892-903. doi: 10.1111/jcpt.13114. Go to original source... Go to PubMed...
    6. Wakeman SE. Opioid Use Disorder Diagnosis and Management. NEJM Evid. 2022 Apr;1(4):EVIDra2200038. doi: 10.1056/EVIDra2200038. Go to original source... Go to PubMed...
    7. Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). Journal of Psychoactive Drugs. 2003;35(2):253-259. Go to original source...
    8. Andrews P, Steultjens M, Riskowski J. Chronic widespread pain prevalence in the general population: A systematic review. European Journal of Pain. 2018;22(1):5-18. Go to original source...
    9. Hayhurst CJ, Durieux ME. Differential opioid tolerance and opioid-induced hyperalgesia: a clinical reality. Anesthesiology. 2016;124(2):483-488. Go to original source...
    10. Menendez ME, Ring D, Bateman BT. Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res. 2015;473(7):2402-2412. Go to original source...
    11. Goel A, Azargive S, Lamba W, Bordman J, Englesakis M, Srikandarajah S, et al. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaesth. 2019;66(2):201-217. Go to original source...
    12. Dickerson DM, Mariano ER, Szokol JW, Harned M, Clark RM, Mueller JT, et al. Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder. Reg Anesth Pain Med. 2024;49(10):716-724. Go to original source...
    13. Green M, Veltri CA, Prozialeck WC, Grundmann O. The neuropharmacology of kratom, a novel psychoactive natural product. Prog Neuropsychopharmacol Biol Psychiatry. 2025 Jan 10;136:111215. doi: 10.1016/j.pnpbp.2024.111215. Go to original source... Go to PubMed...
    14. Huestis MA, Brett MA, Bothmer J, Atallah R. Human Mitragynine and 7-Hydroxymitragynine Pharmacokinetics after Single and Multiple Daily Doses of Oral Encapsulated Dried Kratom Leaf Powder. Molecules. 2024 Feb 23;29(5):984. doi: 10.3390/molecules29050984. Go to original source...
    15. Olsen EO, O'Donnell J, Mattson CL, Schier JG, Wilson N. Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected - 27 States, July 2016-December 2017. MMWR Morb Mortal Wkly Rep. 2019 Apr 12;68(14):326-327. doi: 10.15585/mmwr.mm6814a2. Go to original source... Go to PubMed...
    16. Lund E, Low AB, Allan JD, Puentes JA, Flynn DN. Anesthetic Challenges Posed by Heavy Kratom Users. Cureus. 2022 Mar 5;14(3):e22864. doi: 10.7759/cureus.22864. Go to original source...
    17. Garmon EH, Olson K. Narrative Review of Kratom, an Emerging Psychoactive Substance With Perianesthetic Implications. Anesth Analg. 2022 Dec 1;135(6):1180-1188. doi: 10.1213/ANE.0000000000006177. Go to original source... Go to PubMed...
    18. Jirakulsawat A, Noitasaeng P, Noocharoen N, Apidechakul P, Vichitvejpaisal P. Challenges in Anesthesia Practice with Kratom. J Royal Thai Army Nurses [Internet]. 2023;24(2):46-52. Available from: https://he01.tci-thaijo.org/index.php/JRTAN/article/view/262951.
    19. Chomynová P, Grohmannová K, Dvořáková Z, Orlíková B, Rous Z, Černíková T. Souhrnná zpráva o závislostech v České republice 2022 [Summary Report on Addictions in the Czech Republic in 2022]. Praha: Úřad vlády České republiky. ISBN 978-80-7440-311-8.
    20. Vonghia L, Leggio L, Ferrulli A, Bertini M, Gasbarrini G, Addolorato G; Alcoholism Treatment Study Group. Acute alcohol intoxication. Eur J Intern Med. 2008 Dec;19(8):561-567. doi: 10.1016/j.ejim.2007.06.033. Go to original source... Go to PubMed...
    21. Varghese J, Dakhode S. Effects of Alcohol Consumption on Various Systems of the Human Body: A Systematic Review. Cureus. 2022 Oct 8;14(10):e30057. doi: 10.7759/cureus.30057. Go to original source... Go to PubMed...
    22. Chapman R, Plaat F. Alcohol and anaesthesia. Continuing Education in Anaesthesia, Critical Care and Pain, 2009; 9(1):10-13. Go to original source...
    23. Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA‑Ar). Br J Addict. 1989;84(11):1353-1357. Go to original source...
    24. National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence. [CG115]. [Internet]. 2011. [cit. 2024-11-29]. Available from: https://www.nice.org.uk/guidance/cg115.
    25. Jenkins MJA, Kinsella SM, Wiles MD, Srivastava B, Griffiths C, Lewin J, et al. Peri-operative identification and management of patients with unhealthy alcohol intake. Anaesthesia. 2025 Mar;80(3):311-326. doi: 10.1111/anae.16530. Go to original source... Go to PubMed...

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