In alcohol-dependent in-patients, an adequate
drug prophylaxis should be made in order to lower the degree of a developing alcohol withdrawal syndrome (AWS) or to prevent a life-threatening
delirium tremens. Pre-condition of successful therapy is a precise diagnosis. In patients, the beginning of whose abstinence is known, carefully-targeted pharmacological interventions can prevent severe imbalances of
neurotransmitters. Typical time courses of destabilisation of neural balances should be considered. Since there is no single
drug which is able to influence various transmitter systems, normally the use of
drug combinations is necessary. In ENT-patients, traumatologic patients and patients from the department of maxillo-facial surgery, screening methods based on a simply-structured questionnaire relating to information from the patient and his surroundings and selected laboratory parameters should be used. High-risk patients who could get an AWS or
delirium tremens should be treated prophylactically during their oral
premedication period. Important drugs for successful prophylaxis of an AWS are
benzodiazepines, clonidin,
magnesium and
vitamin B 1. A close-meshed control of the
glucose metabolism,
electrolyte and acid-base balance should be performed. Neuroleptica can be used if there is any indication for their adjuvant use. In severe cases that require
deep sedation or
hypnosis,
propofol or gamma-hydroxy-
butyric acid should be used. Perioperative infusion of alcohol as a prophylactic agent against
delirium tremens is regarded as an obsolete therapeutic measure for ethical reasons and because equally good or better results can be achieved by carefully-targeted
drug therapy. Due to its easy use, however, the application of alcohol has not yet completely disappeared from the therapeutic spectrum.