Smoking before surgery: the case for stopping.

To the adverse effects of smoking noted by King James in 1604 can now be added changes in the cardiovascular, immune, and haemostatic systems. Over 1000 components of cigarette smoke have been identified,' and these may cause wide ranging disturbances of physiology. These compound the risks of anaesthesia and surgery though precise figures concerning the overall increase in operative morbidity and mortality are lacking.2 The important question is: "For what period before operation must patients stop smoking in order to reduce this increase in operative risk?" Very much less is known about the effects of stopping smoking than about those of continuing to smoke. Consideration of the principal pathophysiological changes associated with the habit allows some conclusions to be drawn, however, from the results of studies which have specifically looked at the reversibility of changes induced by smoking. While it is not known precisely which components of cigarette smoke are responsible for the long term cardiovascular hazard3 carbon monoxide and nicotine have important and immediate cardiovascular effects. Carbon monoxide reduces tissue oxygenation by two mechanisms: it reduces the amount of haemoglobin available for combination with oxygen (because of the formation of carboxyhaemoglobin), and it increases the affinity of haemoglobin for oxygen.4 It also probably has a weak negative inotropic action on the heart.' The clinical importance of these effects is shown by the association between cigarettes with a high yield of carbon monoxide and an increase in symptoms of ischaemia in susceptible people.3 In addition, exercise tolerance is reduced in patients with ischaemic heart disease exposed to carbon monoxide.6 At blood concentrations commonly found in smokers nicotine causes an increase in heart rate and blood pressure. Hence nicotine increases demand of the myocardium for oxygen while carbon monoxide decreases the supply. A period of abstention from smoking for 12 to 24 hours preoperatively will allow the elimination of both carbon monoxide and nicotine and improve cardiovascular fitness. 'This is of particular clinical importance in patients with coronary artery disease.

[1]  M. Shipley,et al.  Carbon monoxide yield of cigarettes and its relation to cardiorespiratory disease , 1984, British medical journal.

[2]  M. Murphy,et al.  Reversible alterations in immunoregulatory T cells in smoking. Analysis by monoclonal antibodies and flow cytometry. , 1982, Chest.

[3]  P. Peake,et al.  Postoperative respiratory morbidity: identification and risk factors. , 1982, The Australian and New Zealand journal of surgery.

[4]  J. Repine,et al.  Altered oxidative metabolic responses in vitro of alveolar macrophages from asymptomatic cigarette smokers. , 1981, The American review of respiratory disease.

[5]  G. Turino.  Effect of carbon monoxide on the cardiorespiratory system. Carbon monoxide toxicity: physiology and biochemistry. , 1981, Circulation.

[6]  D. Leaper,et al.  Does increased movement protect smokers from postoperative deep vein thrombosis? , 1980, British medical journal.

[7]  P. Hersey,et al.  Low natural killer‐cell activity and immunoglobulin levels associated with smoking in human subjects , 1979, International journal of cancer.

[8]  P. Laharrague,et al.  Effect of tobacco smoking on the functions of polymorphonuclear leukocytes , 1979, Infection and immunity.

[9]  M A Sackner,et al.  Relationship of smoking history and pulmonary function tests to tracheal mucous velocity in nonsmokers, young smokers, ex-smokers, and patients with chronic bronchitis. , 2015, The American review of respiratory disease.

[10]  J. Repine,et al.  Reversible impairment of the adherence of alveolar macrophages from cigarette smokers. , 2015, The American review of respiratory disease.

[11]  M. Evans,et al.  Cigarette smoking and postoperative deep-vein thrombosis. , 1978, British medical journal.

[12]  J. Anderson,et al.  Effect of cigarette smoking on subsequent postoperative thromboembolic disease in gynaecological patients. , 1978, British medical journal.

[13]  David Hill,et al.  Smoking and Impairment of Performance , 1978, The Medical journal of Australia.

[14]  M. Bierenbaum,et al.  Effect of cigarette smoking upon in vivo platelet function in man. , 1978, Thrombosis research.

[15]  A. Seppänen.  Physical work capacity in relations to carbon monoxide inhalation and tobacco smoking. , 1977, Annals of clinical research.

[16]  B. B. Ross,et al.  The effect of smoking cessation and modification on lung function. , 1976, The American review of respiratory disease.

[17]  P. Macklem,et al.  The early detection of airway obstruction. , 2015, The American review of respiratory disease.

[18]  J. Chalon,et al.  Cytology of respiratory epithelium as a predictor of respiratory complications after operation. , 1975, Chest.

[19]  P. Chodoff,et al.  Short term abstinence from smoking: Its place in preoperative preparation , 1975, Critical care medicine.

[20]  J. Chalon,et al.  Cytology of Respiratory Epithelium as a Predictor of Respiratory Complications after Operation , 1975 .

[21]  A. Handley,et al.  Influence of Smoking on Deep Vein Thrombosis after Myocardial Infarction , 1974, British medical journal.

[22]  P. Emerson,et al.  Increased Incidence of Deep Vein Thrombosis after Myocardial Infarction in Non-smokers , 1974, British medical journal.

[23]  P. Thornley,et al.  Hospital Practice: STOPPING SMOKING AFTER MYOCARDIAL INFARCTION , 1974 .

[24]  P. Thornley,et al.  Stopping smoking after myocardial infarction. , 1974, Lancet.

[25]  N. Fortuin,et al.  Effect of low-level carbon monoxide exposure on onset and duration of angina pectoris. A study in ten patients with ischemic heart disease. , 1973, Annals of internal medicine.

[26]  K. Philipson,et al.  Withdrawal of Cigarette Smoking , 1973 .

[27]  C. Fletcher,et al.  The diagnosis and prophylaxis of pulmonary complications of surgical operation , 1973, The British journal of surgery.

[28]  R. Martin.  Altered morphology and increased acid hydrolase content of pulmonary macrophages from cigarette smokers. , 1971, The American review of respiratory disease.

[29]  K. Philipson,et al.  Withdrawal of cigarette smoking: a study on tracheobronchial clearance. , 1973, Archives of environmental health.

[30]  J. Wightman,et al.  A prospective survey of the incidence of postoperative pulmonary complications , 1968, The British journal of surgery.

[31]  R. Stedman.  The chemical composition of tobacco and tobacco smoke. , 1968, Chemical reviews.

[32]  J. K. Wightman.  A prospective survey of the incidence of postoperative pulmonary complications , 1968 .

[33]  R. M. Shick,et al.  THE CARDIOVASCULAR EFFECTS OF SMOKING WITH SPECIAL REFERENCE TO HYPERTENSION , 1960, Annals of the New York Academy of Sciences.

[34]  H. Morton.  TOBACCO SMOKING AND PULMONARY COMPLICATIONS AFTER OPERATION , 1944 .

[35]  F. Roughton,et al.  THE EFFECT OF CARBON MONOXIDE ON THE OXYHEMOGLOBIN DISSOCIATION CURVE , 1944 .