In: Anesthesia22 Feb 2010
Smoking is an addictive process. The sensation of drawing smoke into the mouth and the effect of nicotine provides smokers with satisfaction. Acute withdrawal may result in increased anxiety, sleep disturbances, and irritability.
EFFECTS OF PASSIVE SMOKING ON ANESTHESIA
In a study by Dennis et al, adverse effects such as coughing, breath holding, and laryngospasm during induction were significantly higher in smokers and passive smokers than in young smokers. There was no difference in the incidence between smokers and passive smokers. During adverse effects, the decrease in the oxygen saturation was greater in smokers and passive smokers. In this study, COHb was a better predictor of adverse effects than the status of smoking.
In children with a history of passive smoking, desat-uration was significantly higher in the postoperative period when compared with that of nonexposed children. The desaturation was related to the cumulative number of cigarettes smoked to which the child was exposed. It had no relationship to the COHb. Thus, the desaturation is probably more due to respiratory infection due to increased risk of exposure to microdroplets from respiratory disease of smokers who cough while smoking than due to exposure to the smoke itself.
MANAGEMENT OF ANESTHESIA IN SMOKERS
Management of anesthesia in smokers includes the following:
Choice of Technique
General Anesthesia Induction
ANESTHESIOLOGISTS’ ROLE IN ADVISING SMOKERS
In recent years, medical officers have been more involved in advising smokers to give up smoking. Preop-eratively, Shah et al gave written advice to patients to stop smoking for 5 days before their operations. Though the majority did not comply with the 5-day advice, the majority had reduced or stopped smoking before the procedure. Verbal advice to stop smoking is regularly given to smokers by anesthesiologists prior to an operation. Many patients follow the anesthesiologists’ advice.
Intraoperatively during anesthesia, tape-recorded messages advising patients to stop smoking have been tried by anesthesiologists, with some success. In one study, some patients reduced their cigarette intake and some stopped smoking. In another study, there was no difference. In the latter study, 8% had stopped smoking after 6 months. The majority of those that stopped were the ones who had had major surgery and those that smoked less than 10 cigarettes a day.
Egan and Wong have suggested that anesthesiologists should advise smokers to stop smoking during the postoperative ward rounds. This should be done especially in those patients who had smoking-related problems during anesthesia. Egan and Wong found patients to be especially compliant in those circumstances.
In conclusion, patients must stop smoking prior to surgery. The best result occurs when the patient stops 8 weeks or more before surgery. Doing so will significantly reduce perioperative-specific respiratory events and postoperative morbidity, and it will eliminate carbon monoxide and nicotine, improve the clearance of tracheobronchial secretions, decrease small-airway narrowing, and improve immune functioning. If the patient does not stop smoking 8 weeks before surgery, the patient should at least stop smoking 12 hours before surgery or, if the surgery is the next morning, the previous evening. This will eliminate problems in tissue oxygen uptake due to carbon monoxide and reduce the cardiac and hemodynamic effects of nicotine. Last, it is time that anesthesiologists played a stronger role in advising patients to stop smoking.
Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.