Smoking

• Smoking


  Risk factor for intraoperative pulmonary complications and a wide range of post-operative pulmonary, cardiovascular and wound related complications
• Smoking

  • Associated with poor outcomes
  • Causes cough, mucous hypersecretion and airflow
  • Passive smokers have an increased incidence of adverse events
• Cardiovascular effects

  • Nicotine Stimulates the adrenal medulla to secrete adrenaline
  • Increases blood pressure
  • Stimulates the sympathetic system
  • Increases myocardial contractility
  • Has a negative ionotropic effect leading to chronic tissue hypoxia
• Pulmonary effects of smoking

  1. Irritants in smoke increase mucus secretion, making it hyperviscous with altered elasticity

  2. Cilia become inactive, impairing tracheobronchial clearance

  3. Smoking leads to narrowing of small airways and increase in closing volume

  4. Increase in proteolytic and elastolytic enzymes leading to loss of elasticity and emphysema

  5. Increased risk of lung infection, 25% of smokers suffer from chronic bronchitis
• Pulmonary effects:

  • carboxyhaemoglobin Levels may be up to 15% in smokers
  • Carbon monoxide has 250 times greater affinity for hemoglobin than oxygen
  • Half-life of carboxyhemoglobin is 4-6 hours
• Smoking has no effect on gastric volume or pH of gastric secretions
• Smoking relaxes the gastroesophageal sphincter but returns to normal within minutes after stopping
• Effects of smoking on other systems

  • Impaired immunity and increased risk of infection
  • Decreases immunoglobulins and leukocyte activity
  • Increases secretion of anti-diuretic hormone leading to dilutional hyponatremia
• Benefits of smoking

  • Reduced risk of PONV
  • Reduced risk of ulcerative colitis
  • Reduced risk of schizophrenia
  • Reduced risk of deep vein thrombosis
• Anesthetic considerations for smokers

  1. Patients advised to quit smoking 4-6 weeks prior to surgery

  2. Abstinence for 12 hrs rids carbon monoxide

  3. Ciliary function improves in 12-24 hrs

  Laryngeal and bronchial activity better in 5-10 days. 4. Sputum volume returns to normal in 2 weeks

  5 Small airway narrowing improves in 4 weeks, tracheobronchial clearance in 3 months
• Anesthetic considerations for smokers

  1. Airway complications on induction common, need for intubation should be anticipated

  2. Pre-oxygenation should be routine

  3. Adequate anesthesia for intubation to minimize bronchospasm risk
• Regional anesthesia has advantages for patients with long term respiratory complications of smoking
• Underlying ischemic heart disease and hypertension should be identified to minimize risk
• Early mobilization is important to improve lung function and sputum clearance