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Alcohol Withdrawal Risk — FRCA Final MCQ

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ModeratePreoperative AssessmentAlcohol Withdrawal RiskFRCA Final

A 55-year-old man presents for elective inguinal hernia repair. He drinks approximately 50 units of alcohol per week, spread throughout the week. If he goes 8–10 hours without alcohol, he develops tremor, sweating and palpitations, which are relieved by drinking. Surgery and hospital admission will abruptly interrupt his usual alcohol intake. Which perioperative complication is most important to anticipate and specifically plan for?

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Correct answer: B — Alcohol withdrawal syndrome

The correct answer is B. Tremor, sweating and palpitations after only 8–10 hours without alcohol, relieved by further drinking, demonstrate physical dependence. Abrupt perioperative cessation therefore creates a substantial risk of alcohol withdrawal syndrome, which commonly begins within 6–24 hours and can progress to seizures or delirium tremens. The plan should include specialist assessment, an appropriate monitored medically assisted withdrawal protocol and consideration of thiamine according to nutritional risk. Harmful alcohol use can impair wound healing, but this is less immediately dangerous than unplanned withdrawal. It does not predict postoperative nausea and vomiting or hypothermia specifically. Anaesthetic drug requirements may be altered by chronic alcohol exposure, but increased sensitivity is not a consistent or defining effect.

Reference: Department of Health and Social Care. Clinical guidelines for alcohol treatment: Chapter 16, Alcohol care in acute hospitals. Updated 17 April 2026. https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/16-alcohol-care-in-acute-hospitals