The anesthetic risk of tobacco smoking

Tobacco smoking is one of the many factors that predispose to postoperative complications. Although smoking affects multiple organs (heart, lungs, blood, immune and nervous systems), the most prominent perioperative morbidity is of pulmonary origin. This article reviews the major effects of tobacco smoke constituents on organ functions and the management principles applying to anesthesia of smokers. It is pointed out that smoking should be discouraged in all patients but that a marked reduction in perioperative complications can already be obtained if cessation of smoking occurs at least 8 weeks before surgery. Such smoke-free interval will benefit the surgical patient by eliminating carboxyhemoglobin, improving ciliary function, decreasing both mucus secretion and small airway obstruction and restoring normal immune function.