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[Preoperative abstinence from smoking. An outdated dogma in anaesthesia?]
1Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Johann Wolfgang Goethe-Universität, Frankfurt/Main. bernhard.zwissler@kgu.de
Der Anaesthesist
|May 17, 2005
Summary
The anesthesia dogma requiring patients to stop smoking before surgery lacks scientific basis regarding pulmonary complications. However, smoking cessation 12-48 hours prior is advised for cardiac risk patients due to potential myocardial ischemia.
Area of Science:
- Anesthesiology
- Pulmonary Medicine
- Cardiology
Context:
- The long-standing recommendation for surgical patients to abstain from smoking shortly before anesthesia is based on assumptions of increased perioperative cardiopulmonary complications.
- The scientific evidence supporting short-term smoking abstinence (within 6 hours) and its impact on pulmonary morbidity has not been systematically evaluated.
Purpose:
- To critically re-examine the scientific rationale behind the anesthesia dogma that forbids smoking in the immediate pre-operative period.
- To investigate the effects of short-term smoking abstinence on perioperative pulmonary complications, including aspiration and other morbidities.
Summary:
- Current evidence does not support the claim that smoking within 6 hours of surgery increases pulmonary aspiration or other pulmonary complications.
- Giving up smoking less than two months before surgery may not significantly reduce, and could potentially increase, perioperative complications.
- While smoking does not affect gastric volume or acidity, it may transiently reduce lower esophageal sphincter tone, an effect reversible within minutes.
Impact:
- The findings challenge the conventional anesthesia dogma regarding pre-operative smoking cessation for pulmonary reasons.
- Acute smoking may increase the risk of myocardial ischemia due to elevated carboxyhemoglobin (COHb) levels.
- Discouraging smoking 12-48 hours before surgery remains advisable for patients with elevated cardiac risk to mitigate potential cardiac complications.