Transdermal nicotine increases heart rate after endotracheal intubation

Transdermal nicotine reduces perioperative withdrawal symptoms when smoking is forbidden. We evaluated the influence of a transdermal nicotine system on cardiovascular response after endotracheal intubation. The study design was prospective, randomized, double-blind and placebo- controlled. Sixty healthy smokers scheduled for minor surgery under general anesthesia were divided into two groups. The first group received a 21 mg/day transdermal nicotine system while the second group received a placebo transdermal system. After induction with standardized doses of fentanyl, thiopental and atracurium, the patients were intubated immediately when EMG-response decreased to 10% of the initial control. Heart rate and noninvasive arterial pressures were recorded 1 min and 5 min after intubation. The transdermal nicotine system significantly increased heart rate compared with the control group without nicotine substitution. Since the transdermal nicotine system increases heart rate it should not be used if tachycardia is potentially dangerous, such as in patients with ischemic heart disease.