I have a friend who is an RN, who is going to be having surgery on April 7th. She works at the place she is going to have surgery, and is paranoid that they are going to know how much alcohol she really drinks, which she really doesn’t drink everyday or everyhour, but goes on binges, or sometimes everday for a week and takes two days off for on call. Anyway the big question is, as she has heard at work from other cases, is the anethitists or anethesiologist , once made a comment on how they had to keep given this patient more drugs, as he must be a frequent drinker. So my question is, first of all is this true, and how long do you have to give your system a break, so you do not have to use up so many drugs to keep you asleep. I am sure this is a common thing to do with tolerance, and such but would be interesting to know, how this really works.
Thanks
Yes, it’s true and it works by presenting such a load of drug (ethanol and others) to the liver to detoxify on a regular basis that the liver has to fire up extra processes to break down the drugs. This is via microsomal enzymes in the liver.
So the patient goes into surgery, is given anesthetics, and has these same enzymes break down these anesthetic drugs at a more rapid rate than expected for a normal metabolism.
If the person is drug and alcohol free for 3 or 4 months or more, these enzymes get de-activated and metabolism tends to normalize as far as drug detoxification goes.
Sounds like this RN needs rehab in addition to surgery.
Agreed. They have a problem if they’re afraid it will be found out by workers in this way. You summed up everything so well.
Is this because the anesthetic drugs are similar to alcohol, or would you have the same effect if you regularly take a lot of ibuprofen or something?
Look at the table labeled “Inducers” in this link: Drug Interactions, Clinical Pharmacology, Department of Medicine
These drugs are best known for stimulating the Cytochrome P450 microsomal enzyme pathway, the most common liver pathway for alternate metabolism. Ibuprofen should have no effect.
Fascinating table, thanks for linking. So ibuprofen won’t hurt, but broccoli, brussel sprouts, char-grilled meat, and St. John’s wort might?
Hurt? Probably not. But in sufficient amounts they will also induce the MEOS.
But most people don’t take broccoli, brussels sprouts, char-grilled meats or St. John’s wort as enthusiastically and chronically and as in such high doses as they take ethanol.
That is fascinating. Sorry for the hijack, but do you know a good on-line site for such information on recovery from alcohol abuse?
I’m not sure. My knowledge has been gleaned from decades of experience as both a physician to the chemically dependent and being recovering my own self.
You might try http://www.asam.org/, the web site of the American Society of Addiction Medicine, there’s lots of resources there.
Otherwise, AA’s website has tons of stuff about recovery from alcohol abuse, but I’m not sure if that’s just what you’re looking for. http://www.alcoholics-anonymous.org/?Media=PlayFlash
Hmm. Thanks for those links,QtM, I will browse through them. Specifically, I got to thinking about the sort of thing that they tell you about smoking cessation; such as, ‘within X months your lungs will be back to X% capacity’. The kind of thing one would use to help encourage someone to drink in moderation, or to quit altogether.
Quick question, sorry to hijack: the P450 enzymes are inducible, but the alcohol/aldehyde dehydrogenases are not, correct?
That is my understanding, but I am not a biochemist. The dehydrogenases are are set up to go when alcohol/other substrate shows up on scene, the microsomal enzymes have to get the signal that they’re needed, gear up, get to work, gear up more if they’re needed more, then pack up and move out after they’ve been idle long enough.
Again, I’m not a biochemist, but that’s how I was taught. A few decades ago now. :eek:
Come to Tuesday Night FarkAnon at eight PM weekly
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Years ago when I worked in hospital, we had a young man in for some relatively simple surgery (I think it was a cyst removal or something like that.) His buddies got him good and drunk the night before, and he came out of anesthetic with a bang. They had to call in three big attendants to hold him down.
So before I was even old enough to drink I saw first-hand that alcohol +general anesthetic = bad thing.
I actually asked because a few weeks ago, my TA in clinical biochemistry mentioned something about inducibility/non-inducibility, but he didn’t sound too sure of himself. This makes a bit more sense now, thanks.
…and it’s great fun asking practicing physicians basic science questions, they usually hem and haw and tell me to quit bothering them. 
Oh wow, this is very interesting to know. I will have to tell her it is too late and she might as well just come to reality, and realize that they are going to know that she drinks. How many drinks do you think a person could have per day? What if you just have a couple of glasses of wine with supper every night? Or say you have an average of 4 mixed drinks per night, does it still take the same amount of time?
Thanks for information, I finally found an interesting topic to talk about.
So all these inducers, could have the same affect of alcohol if you were to eat these in big amounts. Is this why they say not to smoke tobacco 24 hours before surgery, or maybe 12, I can’t remember. I have been told they can also tell the smokers from the nonsmokers, as when you extubate, or pull the tube out, smokers tend to cough consistently.
They can tell the smokers from the nonsmokers because:
a) The smokers are there for the peripheral artery bypasses
b) The smokers are the ones whose incisions split open like rotten melons four days later
c) The smokers are the ones that set off the fire alarms in the bathroom
d) The smoker’s ET tube and vent circuit smell like smoke
Take your pick.[/hyperbole, except for d]
Ha Ha Ha, you must be a non-smoker
Yes. And a surgeon.