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Case Reports in Anesthesiology
Volume 2013, Article ID 761527, 3 pages
http://dx.doi.org/10.1155/2013/761527
Case Report

Intraoperative Alcohol Withdrawal Syndrome: A Coincidence or Precipitation?

Department of Anaesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan 56700, Nepal

Received 2 May 2013; Accepted 17 June 2013

Academic Editors: A. Apan, A. Han, D. Lee, H. Shankar, A. Trikha, and E. A. Vandermeersch

Copyright © 2013 Asish Subedi and Balkrishna Bhattarai. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

As the prevalence of alcohol dependence is approximately half in surgical patients with an alcohol use disorder, anesthetist often encounters such patients in the perioperative settings. Alcohol withdrawal syndrome (AWS) is one of the most feared complications of alcohol dependence and can be fatal if not managed actively. A 61-year-old man, alcoholic with 50 h of abstinence before surgery, received spinal anesthesia for surgery for femoral neck fracture. To facilitate positioning for spinal anesthesia, fascia iliaca compartmental block with 0.25% bupivacaine (30 mL) was administered 30 min prior to spinal block. Later, in the intraoperative period the patient developed AWS; however, the features were similar to that of local anesthetic toxicity. The case was successfully managed with intravenous midazolam, esmolol, and propofol infusion. Due to similarity of clinical features of AWS and mild local anesthetic toxicity, an anesthetist should be in a position to differentiate the condition promptly and manage it aggressively.