Jan Stewart Lecture to Focus on Patients with Substance Use Disorder

The 2017 Jan Stewart Memorial Wellness Lecture will be at 8:15 a.m. on Sunday, Sept. 10, in ballroom 6A. This year’s lecture will feature a panel of experts addressing the topic of “Safe Anesthesia Care of the Patient with Substance Use Disorder.” The panel of Olin (Brad) Hutto, MHS, CRNA; Jessica Switzman, MSN, CRNA; and Brian Selai, MSN, CRNA, CPT, USA(ret) will be moderated by Linda Stone, DNP, CRNA. Stone took some time to answer some questions about the panel.

Q: What are some of the different viewpoints you hope to bring to the topic of anesthesia for a patient with substance use disorder (SUD)?

A: Since every member of the panel has a different background, we hope to bring our various experiences working with SUD to the discussion. Some members of the panel have a personal history of SUD, while others don’t. All of us have administered anesthesia to patients with SUD in recovery as well as those actively using drugs. We have also helped many CRNAs and SRNAs get the information and support they need to get into treatment and begin the recovery process. We want to show the complexity of the disease as well as the various ways that CRNAs can administer anesthesia to patients with SUD safely.

Q: What’s the biggest difference between the care of a patient with SUD and one without? 

A: This is a very complex question, and there is no black-and-white answer. I asked several members on the Peer Assistance Advisors Committee with me to respond to this question. Our collective response is: “Patients with SUD are treated according to many things, but primarily based on their recovery status and whether or not they are on medication-assisted treatment. Those who are in recovery with a long history of abstinence may have a lower anesthetic requirement than other patients. Patients on Suboxone therapy may have a higher requirement, especially if it has been stopped preoperatively. With patients on Vivitrol, it may be very difficult to control their pain. Vivitrol can prevent endorphins from being as effective. Patients actively using may have a greatly increased requirement depending on when and what they last used. Patients with SUD in recovery may be frightened about the potential for relapse after receiving anesthesia, so it is very important to talk to them pre-operatively about having a post-operative support plan in place—talk to their sponsors, family, friends, and to seek help with an addiction professional if necessary. Using anesthesia techniques where little-to-no opioids are used can be very helpful in the SUD population, but also in many other types of patient populations. One of the biggest problems with these patients is their post-operative course. It is sometimes very difficult to control post-operative pain in those with SUD.”

Q: What’s your own experience dealing with patients with SUD?

A: My own experience with patients with SUD is varied. I have administered anesthesia to patients in recovery and to those who are actively using. Anesthetics should be tailored to the individual patient, and having non-opioid options are really helpful in providing anesthesia to these patients. I have found that talking with patients pre-operatively and developing rapport is the best way to develop the safest and most effective perioperative plan for patients with SUD.

Q: What information do you hope panel attendees come away with?

A: We all hope to provide the attendees with a better understanding of SUD. In addition, we hope that they learn about non-opioid options for providing anesthesia to patients with SUD as well as other patient populations. We also hope that they will be able to use the knowledge they have gained from the discussion in their own practice for patients with SUD.