De-addiction: A new risk for anesthesia

Sir, These days we encounter several patients of substance dependence for elective surgical procedures or in an emergency. These patients at that time may be either addicted to them or on de-addiction treatment. Physical addiction to any drug is a function of multiple neuroadaptations (tolerance, sensitization, and withdrawal) of the body to the effect of the drug.[1] Smokeless tobacco or finely ground tobacco (also called snuff), often consumed by placing it next to the gingival/buccal mucosa, is more common in rural than urban areas.[2] The amount of free nicotine available depends on the concentration of nicotine in the product and pH level of the product. With the increase in pH, the percentage of unionized nicotine increases, which is readily absorbed through the mucous membrane.[3] Just asking the patient to quit tobacco and not offering any alternative is stressful for the patients. Anesthesiologists must be skilled enough in establishing a good rapport with the patients to extract the history of the current or past addiction during preanesthetic visits.[4] In this case, the patient was already using fennel seeds as a substitute of tobacco chewing, but we failed to retrieve this information from the patient.