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Acute smoking increases ST depression in humans during general anesthesia
H J Woehlck1, L A Connolly, M P Cinquegrani
1Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, USA.
Anesthesia and Analgesia
|October 8, 1999
Summary
Recent smoking before surgery increases the risk of ST segment depression in patients without heart disease. This cardiac event is linked to both smoking and increased heart rate-pressure product, with females at higher risk.
Area of Science:
- Cardiology
- Anesthesiology
- Cardiovascular Physiology
Background:
- Acute smoking is a potential risk factor for perioperative cardiac events.
- ST segment depression during general anesthesia can indicate myocardial ischemia.
- Patients undergoing noncardiac surgery often have undiagnosed ischemic heart disease.
Purpose of the Study:
- To investigate the association between acute smoking and ST segment depression during general anesthesia in patients without ischemic heart disease.
- To identify predictors of ST segment depression in this patient population.
Main Methods:
- Prospective study measuring expired carbon monoxide (CO) concentration and hemodynamic data during general anesthesia.
- Logistic regression analysis to determine predictors of ST segment depression (≥1 mm).
- Inclusion of patients undergoing noncardiac or nonperipheral vascular surgery without symptoms or evidence of ischemic heart disease.
Main Results:
- Expired CO concentration (indicator of recent smoking) and rate pressure product were significant predictors of ST segment depression.
- Increased expired CO concentration (OR 1.05 per ppm) and rate pressure product (OR 1.20 per 1000 increase) were associated with higher odds of ST depression.
- Approximately 25% of chronic smokers smoked on the morning of surgery despite pre-operative instructions.
Conclusions:
- Patients under 65 without ischemic heart disease symptoms who smoked shortly before surgery experienced more rate pressure product-related ST segment depression.
- Females were at greater risk of ST segment depression compared to males.
- Acute smoking is an independent risk factor for perioperative ST segment depression in specific patient groups.