Craving and withdrawal syndrome during perioperative laparoscopic cholecystectomy: a case study

Abstract

Polysubstance use presents a growing challenge to patient safety in the perioperative period. Abrupt cessation of use, frequently due to preoperative fasting, hospital restrictions, and analgesia/anesthesia, can precipitate withdrawal syndrome and craving, with hemodynamic, behavioral, and adherence repercussions that complicate the postoperative course. A 28-year-old woman, scheduled for elective laparoscopic cholecystectomy for symptomatic cholelithiasis confirmed by ultrasound, reported the use of tobacco, cannabis, methamphetamine/crystal meth, and alcohol. She presented with intense anxiety and signs of withdrawal (blood pressure 145/92 mmHg, heart rate 118 bpm, respiratory rate 22 rpm, body temperature 37.1 °C, tremor, sweating, insomnia, agitation). In the intervention, the nursing team applied guided breathing, emotional support, and spiritual facilitation, using a multidisciplinary approach. Clinical improvement and a decrease in scores were observed on the Fagerström Test for Nicotine Dependence, the Alcohol Craving Questionnaire Short Form Revised, the Marijuana Craving Questionnaire Short Form, and the Desires for Drug Questionnaire. Improvements were also seen in the administered instruments, such as the Minnesota Nicotine Withdrawal Scale, the Clinical Institute Withdrawal Assessment for Alcohol, the Cannabis Withdrawal Scale, and the Amphetamine Withdrawal Questionnaire. Withdrawal from multiple substances intensifies autonomic activation and craving. Gender-sensitive perioperative screening and non-pharmacological management protocols are needed.