Hello! I'd like to ask a medical question about a fictional character if I may. I read somewhere that a history of alcohol abuse or surgeries of the stomach require a different approach for anesthetizing a patient. Is this true? How would you treat the pain of a chronic alcoholic about to undergo surgery for a peptic ulcer? Would they be given anything before surgery? Appreciate your time! (Also, Herz is precious.) :)
Hello!
Let’s start from surgery indications. Peptic ulcer doesn’t require a surgery unless a). It’s a perforated ulcer, b). It’s a reoccurring ulcer.
In the a case scenario - it’s an emergency situation, the whole medical approach is different, because the patient is near death and needs to be treated asap. The pain is super great in this case, he’d receive the strongest pain medication (opioid, probably fentanyl, in poorer hospitals morphine, both intravenous) right away.
In the b case scenario, a planned surgery is performed. Anesthesia is no different from any other laparoscopic intervention. A history of alcohol abuse usually means bigger doses of any medication needs to be used for anesthesia induction and maintenance. No special pain management before the surgery itself is required, the ulcer doesn’t cause great pain, BUT he would definitely receive strong premedication 1h- 0,5h before the surgery as an alcoholic. Usually it’s done with psychoactive drugs (benzos, usually midazolam), so he’d receive the larges allowed dose in his butt OR he’d be premedicated with a clonidine pill, which helps reduce withdrawal anxiety.
Hope this helps, feel free to text me again 👍
