Vol. 76 - No. 1 MINERVA ANESTESIOLOGICA 29 MINERVA MEDICA COPYRIGHT ® ORIGINAL ARTICLE Improving the detection of illicit substance use in preoperative anesthesiological assessment R. KLEINWÄCHTER, F. KORK, E. WEISS-GERLACH, A. RAMME, H. LINNEN, F. RADTKE, A. LÜTZ, H. KRAMPE, C. D. SPIES Department of Anaesthesiology and Operative Intensive Medicine, Charité Universitätsmedizin, Berlin, Germany I llicit drug use (ISU) is a worldwide burden; 185 million people (3.1%) of the global population, including infants and the elderly, consume illicit drugs. Polydrug use is frequently observed. 1 The effects of ISU on general anesthesia and perioperative complications or outcomes have not been well investigated. Higher anesthetic require- ments and increased irritability of the upper air- ways have been reported in patients who consume cannabinoids. 2, 3 A recent systematic review found long-term cannabis smoking to be associated with increased respiratory symptoms. 4 Cocaine use is associated with increased risk of arrhythmias and myocardial infarction. 5 There are case reports of rhabdomyolysis and stroke in cocaine-abusing patients undergoing surgery. 6 Amphetamines can cause hyperthermia, rhabdomyolysis, coagulopa- thy and renal failure. Intraoperatively, cardiac arrests have been reported in chronic ampheta- mine users. 7, 8 Perioperative complications in opi- oid-abusing patients, such as hyperalgesia and withdrawal, can be avoided by using regional anal- gesia; however, complications such as torsades de pointes and ventricular tachycardias will remain ABSTRACT Aim. Illicit substance use (ISU) is a worldwide burden, and its prevalence in surgical patients has not been well inves- tigated. Co-consumption of legal substances, such as alcohol and tobacco, complicates the perioperative management and is frequently underestimated during routine preoperative assessment. The aim of this study was to compare the anesthesiologists’ detection rate of ISU during routine preoperative assessment with a computerized self-assessment ques- tionnaire. Methods. In total, 2,938 patients were included in this study. Prior to preoperative assessment, patients were asked to complete a computer-based questionnaire that addressed ISU, alcohol use disorder (AUDIT), nicotine use (Fagerström) and socio-economic variables (education, income, employment, partnership and size of household). Medical records were reviewed, and the anesthesiologists’ detection of ISU was compared to the patients’ self-reported ISU. Results. Seven point five percent of patients reported ISU within the previous twelve months. ISU was highest in the age group between 18 and 30 years (26.4%; P<0.01). Patients reporting ISU were more often men than women (P<0.01), smokers (P<0.01) and tested positive for alcohol use disorder (P<0.01). Anesthesiologists detected ISU in one in 43 patients, whereas the computerized self-assessment reported it in one in 13 patients. The detection was best in the subgroup self-reporting frequent ISU (P<0.01). Conclusion. Anesthesiologists underestimate the prevalence of ISU. Computer-based self-assessment increases the detection of ISU in preoperative assessment and may decrease perioperative risk. More strategies to improve the detec- tion of ISU as well as brief interventions for ISU are required in preoperative assessment clinics. (Minerva Anestesiol 2010;76:29-37) Key words: Drugs - Surgical procedure, operative - Outcome.