[Tobacco smoking and the perioperative period]

In this review we present the pathophysiology of tobacco smoking and its effect on respiration, circulation and the digestive tract. Smokers have a higher risk of postoperative respiratory complications. Smoking approximately 20 cigarettes a day over twenty years significantly influences the development of pulmonary events, particularly hypoxemia and bronchospasm. In smokers, the risk of perioperative acute myocardial ischemia and infarctions is doubled, and the healing process is compromised. Smoking should be stopped before surgery and anaesthesia. Perioperative abstinence lasting 6 to 8 weeks decreases the risk of perioperative complications by 34%, but when the abstinence lasts only 1 to 3 weeks there is no improvement. Shorter periods of abstinence (24-48 hours) are not recommended, as they may be associated with withdrawal syndrome.