Vaping: Anesthesia Considerations for Patients Using Electronic Cigarettes

Anesthetists are generally familiar with the perioperative implications of patients' cigarette smoking. Electronic cigarettes are, however, a relatively newly popular phenomenon among adolescents and young adults. There is a generalized lack of knowledge among healthcare providers regarding the overall health effects of electronic cigarettes, which often are advertised as a harmless smoking-cessation tool. US health protection agencies have reported that electronic cigarettes contain cytotoxic compounds and harmful byproducts such as nicotine, heavy metals, propylene glycol, diacetyl, and other impurities. The current literature suggests that components of these devices (the liquid and heating element) produce chemicals that can cause acute and chronic multiorgan toxicities. On a cellular level, the pulmonary, cardiovascular, immunologic, and pharmacologic effects of electronic cigarettes are most noteworthy. The purpose of this article is to inform anesthesia providers regarding the pathophysiologic effects and anesthetic implications of electronic cigarette use.