TRENDS IN THE MANAGEMENT OF ALCOHOL-WITHDRAWAL SYNDROME

Alcohol use among head and neck cancer patients is common. Alcohol wit hdrawal (especially delirium tremens) poses significant potential morb idity to postsurgical patients. Treatment with newer benzodiazepines ( BZDs) such as lorazepam and midazolam has become more widespread, and mortality rates from severe alcohol withdrawal have decreased in recen t years. The authors retrospectively studied 102 patients with a diagn osis of alcohol withdrawal, including 20 patients undergoing surgery f or cancer of the head and neck. There were 81 men and 21 women, with a mean (+/- standard deviation [SD]) age of 5(2.3 (+/-16.1) years. Many of these patients (46%) were treated with more than one BZD or other neuroleptic, while 49% received single agent therapy of either chlordi azepoxide (26%) or lorazepam (23%). Delirium tremens occurred in 12% o f all patients undergoing withdrawal and in 10% of head and neck cance r patients, with a mortality rate of 9% and 0%, respectively. Single a gent use was successful in greater than 95% when either lorazepam or c hlordiazepoxide was used. Instances of combination treatment where old er BZDs were used yielded a 69% success rate. The higher complication rate and lower treatment success with combination treatment was multif actorial. Optimal management of the alcohol withdrawal syndrome requir es an understanding of its pathophysiology and the principles of its p revention along with a familiarity of BZD pharmacokinetic drug profile s. The authors present a treatment plan which is cost-effective, keeps morbidity low, and should allow a continued decreasing trend in morta lity rates from delirium tremens.