Tobacco control for anesthesiologists

Abstract

Anesthesiologists daily witness the consequences of tobacco use, the most common preventable cause of death. Smoking-related diseases such as atherosclerosis and chronic obstructive pulmonary disease increase anesthetic risk, and even smokers without overt disease are at increased risk for morbidity such as pulmonary and wound-related complications. Evidence suggests that stopping smoking will reduce the frequency of these complications. Nicotine and the other constituents of cigarette smoke, such as carbon monoxide, have important physiologic effects that may affect perioperative management. In addition, it is now apparent that the scheduling of elective surgery represents an excellent opportunity for smokers to quit in the long term. This review serves as an introduction to tobacco control for anesthesiologists, first examining issues of importance to perioperative management. It then discusses how anesthesiologists and other perioperative physicians can help address tobacco use, both at an individual level with their patients, and by contributing to the implementation of effective public health strategies in their countries. Anesthesiologists can play a key role in helping their patients quit smoking. Effective tobacco control measures applied to surgical patients will not only improve immediate perioperative outcomes but also long-term health.

Anesthesia implications of waterpipe use

“…However, based on data from cigarette smoking patients regarding COHb and nicotine levels, refraining from waterpipe use for at least 12 hours (about three COHb elimination half-lives) before elective surgery, as is often recommended for cigarette smokers, is probably desirable [7,9,20]. Since COHb may reach levels markedly higher in waterpipe users than in cigarette users, this recommendation is likely even more important [12].…”

Carboxyhemoglobin and Methemoglobin as Markers of Postoperative Pulmonary Complications

“…Many studies suggest determination of COHb in clinical practice [20] . The risk of anesthesia and the incidence of postoperative respiratory complications are increased in smoking population [21] . It has been reported that COHb is produced by the interaction of volatile anesthetics, including sevo¬flurane [22] .…”

Brief Advice Offered by Anesthetic Personnel to Encourage Smoking Cessation in Ambulatory Gastrointestinal Endoscopic Patients in a Developing Country

“…Previous research has identified numerous barriers to staff delivery of cessation advice [21,22] . In our view, anesthetic personnel may not fully appreciate the risks of smoking in the immediate perioperative period.…”