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The anesthetic management of the patient with unhealthy alcohol use is challenging. Chronic alcohol intake results in numerous co-morbid diseases, physiologic changes and pharmacologic alterations leading to increased perioperative morbidity and mortality. Hence anesthesiologists should search for chronic and acute effects of alcohol abuse when managing such patients. Also, the anesthetic approach of these patients must be adapted to prevent perioperative complications, including withdrawal symptoms. Last, the preoperative period is on opportunity to initiate alcohol withdrawal, with patient's agreement and collaboration.La gestion anesthésique du patient ayant une consommation d’alcool pathologique est difficile. La consommation chronique d’alcool entraîne de nombreuses pathologies, des modifications physiologiques et des changements pharmacologiques, entraînant une augmentation de la morbidité et de la mortalité périopératoires. Par conséquent, les anesthésistes doivent rechercher les effets chroniques et aigus de l’abus d’alcool lors de la prise en charge de tels patients. En outre, l’approche anesthésique de ces patients doit être adaptée pour prévenir les complications périopératoires, y compris les symptômes de sevrage. Enfin, la période préopératoire est l’occasion de commencer le sevrage alcoolique, avec l’accord et la collaboration du patient.

Synthesized as anesthetic agent about fifty years ago, ketamine (Ketalar) has been supplanted by more attractive anesthetic agents with less adverse effects. Nevertheless, the potential of this drug, although often unknown by many practitioners, remains significant. Nowadays, ketamine is more and more used in the treatment and prevention of hyperalgesia and chronicisation of postoperative pain. Indeed, ketamine interacts with NMDA-receptors involved in spinal neuroplasticity and hyperexcitability responsible for these phenomena. Moreover, its efficacy to treat acute pain resistant to classic analgesics makes ketamine a very interesting and clinically-relevant drug for all practitioners facing this type of pain. This article reviews the clinical benefits of ketamine which has sometimes suffered from a negative reputation, but which possesses recently reconsidered wonderful pharmacological properties.