Expert: Ronald Levy, M.D. - 4/13/2008

Question
QUESTION: Dr Levy,
My husband, John, who is 62 went into the hospital for a full knee replacement on 1/21.  After the surgery, the bone doctor met with me to give me the results of the surgery.  He told me it was the hospitals protocol to have the patient on a "detox program" if they were a known drinker and since my husband told him during their many consultations over the years,  he drinks a "couple of beers at night with maybe a shot of bourbon here and there" the doctor let the hospital know this.  Dr. Levy when I saw my husband after the surgery and for 6-7 days after that it was like he was sooooooooo drunk.  They would tie him down some nights for fear he would get up and try to walk.  It was the most horific thing I have ever been through in my life.  I questioned and questioned what was going on.  The bone doctor said this was bad and he had not experienced anything like this in his practice.  But that my husband was clearly having withdrawals and they were giving him drugs to help him get through it.  I kept insisting my husband has gone weeks without drinking and has NEVER gone through anything like this.  Finally what put my questions to rest was when the hospital doctor told me to forget about what I was seeing and trying to figure out this and that, the medical records show my husband was clearly going through withdrawals.  I have tried to find articles on alcohol and anesthesia reactions and can't find anything.   Can you shed some light on this?  Was it the anesthesia and alcohol in his system that triggered his body into shock like this?  that's how I have come to understand it, but sometimes at night I think "I may NEVER know what happened in that hospital".  Please help me understand what may have happened.  Is it possible the detox medication they automatically put him on cause him to act like he was drunk and crazy for 6 days?  I forget the name of the drug they had him on at first and said it wasn't working that well, then they put him on fenabarbitol (sp) and said really nothing was working until after 6 or so days he started coming around and back to somewhat normal.  He had a real bad temper and you couldn't say anything to him for days after we got home.  Very argumentive.  Again, I wonder if my husband went through all this because he was labeled a "drinker" which he is, but like I said, he's gone weeks without a drink and NEVER had withdrawals before.  Or was it the anesthesia and alcohol in his body that did this?
Thanks for any help,
T.Rogers

ANSWER: The problem you are describing is not related to anesthesia. If they put your husband on a detox program, they were likely giving him Valium, Vit B1, and Folic acid. The Valium can cause disinhibition and make him appear drunk but if he was actually going through Delirium Tremens (DT), then the other treatments they gave were appropriate. I know it's not something pretty to see but DT can be fatal if not treated aggressively. The Phenobarbital he received was a barbiturate that is used when Valium doesn't work and can cause sedation, is hynotic and can cause depression.

The question is whether he should have been started on these meds at all (i.e. did the meds cause a problem that might not have existed) but I can't answer that question. The fact that he has gone for days without DTs is not related because he would have started to drink when he felt early symptoms and also nutrition is a big factor in DTs. As for anesthesia causing this, it's actually the opposite, anesthesia can be a treatment for it.

Hope this helps,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Thank you for the quick response.  The drug was Ativan that my husband was first put on.  And I read that it could have side effects of just the opposite of what it's intended use is.  It IS used for alcohol detox to help the patient through it, but can also have adverse side effects in making the patient hallucinate, very agitated and in a drunken state.  I just read this in trying to find the name of the drug for you.  I wonder also and asked the question, what was he doing to show signs of withdrawal after the surgery.  I never got a clear answer, and I suppose since it was the hospitals "protocol" this was not an issue.  He was going to be put on this detox program regardless of any signs shown.  Our bone doctor said this hospital lost a person either in surgery or coming out of surgery for this reason of him being an alcoholic and noone knowing and they vowed it would never happen again!  Hence, the policy put in force.  
As I said before, I will never know what triggered what, but will always wonder in  my heart if the hospital, unententionally caused what would have been a 3 day stay to turn into an extended 7 days, or did they actually save my husbands life by helping him through a life threatening situation.
Thanks again for your prompt response and any further comments welcome.
Tina Rogers

Answer
Ativan is similar to Valium and you are correct in that it can cause the symptoms you describe. Believe it or not, these symptoms are better than the DTs they try to prevent. As for the protocol, if you try to treat DTs after they start it is much harder than before so he didn't have to show signs for them to start the protocol. As to whether it would have been a 3 day stay or 7 day stay, think about the fact that it could have been a several week stay if he had DTs so 7 days isn't so bad. With preventative medicine we never know if the patient would have actually developed the problem we are treating. We would rather err on the side of safety and accept a few patients like you husband (that are borderline) than lose one patient by not treating.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston