Anesthetic considerations in smokers: A scoping review

Tobacco smoking is a well-established modifiable risk factor that significantly influences perioperative outcomes through complex physiological and pharmacological mechanisms. Despite widespread awareness of its long-term health consequences, a considerable proportion of surgical patients continue to smoke at the time of their procedures. The objective of this review is to synthesize current evidence regarding the impact of smoking on anesthetic management. Smoking induces chronic inflammation and structural changes in the respiratory tract, which may increase the risk of intraoperative hypoxemia, bronchospasm, and postoperative pulmonary complications. Cardiovascular risks are similarly elevated due to smoking-related endothelial dysfunction, increased sympathetic activity, and impaired myocardial oxygen balance. Moreover, nicotine and other components of tobacco smoke alter drug metabolism, particularly via hepatic enzyme induction, affecting the pharmacokinetics of commonly used anesthetics and analgesics. Smokers also exhibit altered pain perception and increased opioid requirements postoperatively, complicating analgesic strategies. In conclusion, an in-depth understanding of the multifaceted effects of smoking on anesthetic care is essential for optimizing outcomes and reducing perioperative morbidity in this high-risk group.