Smoking And Anaesthesia

By Dr. Manish Rai in Anaesthesia

Jan 12 , 2022 | 2 min read

The WHO has described tobacco as, ‘the only legal drug that kills many of its users when used exactly as intended by manufacturers’. Smoking is the primary cause of preventable illness and premature death. Smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general. Smoking not only has harmful effects on general health but can also increase the risk when having anaesthesia and surgery.

Cigarettes, beedi, cigars, pipes, hookahs & passive smoking are different methods of tobacco smoking. The effects of any drug (including tobacco) vary from person to person. There is no safe level of tobacco use. When someone smokes, cigarette creation of heated aerosol and gas by vaporization allows deep penetration and inhalation into the lungs where active substances absorb into the bloodstream.

Classification of smokers:-

a. Heavy smokers (> or = 20 cigarettes /day)
b. Light smokers   (< or = 19 cigarettes/day)
  • Current Smoker- Who have smoked >100 cigarettes in their life time & currently smokes.
  • Former Smoker- Who has smoked >100 cigarettes in their life time & do not currently smokes.
  • Non Smoker- Who has not smoked >100 cigarettes in their life time & do not currently smokes.

Cigarette smoke is far more than a triad of tar, nicotine, and carbon   monoxide.

Nicotine increases the heart rate, heart pumping, blood pressure, and blood vessel narrowing. Due to nicotine the metabolism of many drugs is altered including few of the aneasthetic drugs. 

Smokers have a decreased ability to carry oxygen in the blood. Carbon monoxide has around a 300-fold greater affinity for haemoglobin than the affinity of oxygen for haemoglobin, and therefore the formation of carboxyhaemoglobin is favored over the formation of oxyhaemoglobin. 

Smokers have an increased production of mucous, which can clog up the airways. They also have increased sensitivity of the airways, which makes the airways more prone to narrowing during anaesthetic. This airway narrowing impedes delivery of oxygen and can be life threatening. 

Surgical wound complication rates are higher in smokers, particularly following plastic and reconstructive surgery, bone surgery, bowel surgery and microsurgery. Smoking has adverse effects on the blood flow to tissues that may impair wound healing.

Quitting smoking before surgery leads to a reduced incidence of postoperative complications. The longer the period of cessation before surgery, the greater the benefit.

Smoking should not be permitted within 12 hours of surgery.  Even a relatively short period of abstinence from smoking helps to avoid some of the adverse effects. For the greatest benefit, one should aim to quit smoking at least 8 weeks prior to elective surgery. 

Benefit of quitting smoking before surgery & anaesthesia –

  • Abstinence of 12 hours is sufficient to get rid of carbon monoxide. 
  • Nicotine levels returns to normal within 12 to 24 hours.
  • Ciliaery activity starts to recover within 6 days.
  • It takes 5 to 10 days for laryngeal and bronchial reactivity to settle.
  • The sputum volume takes 6 weeks to return to normal.
  • Tracheo-bronchial clearance improve after 3 months.

Abstinence of 8 weeks prior to elective surgery can prevent most reversible damage.

Surgery & Anaesthesia — A great opportunity to quit Smoking.
Quitting completely is the only way to stop.