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Environmental tobacco smoke exposure is associated with lower preoperative PEFR values, but does not impact on recovery from anesthesia for healthy children undergoing ambulatory anesthesia. O'Rourke JM1, Kalish LA, McDaniel S, Lyons B. The effects of exposure to environmental tobacco smoke on pulmonary function in children undergoing anesthesia for minor surgery. Paediatr Anaesth. 2006 May;16(5):560-7.


In children undergoing general anaesthesia for inguinal hernia repair, ETS exposure was associated with an increased frequency of respiratory symptoms during emergence from anaesthesia and during postoperative recovery. Drongowski RA, Lee D, Reynolds PI, Malviya S, Harmon CM, Geiger J, Lelli JL, Coran AG. Increased respiratory symptoms following surgery in children exposed to environmental tobacco smoke. Paediatr Anaesth. 2003 May;13(4):304-10.


Carbon monoxide has the propensity to promote vascular remodeling and increase pulmonary vascular resistance in vivoCarraway MS, Ghio AJ, Suliman HB, Carter JD, Whorton AR, Piantadosi CA. Carbon monoxide promotes hypoxic pulmonary vascular remodeling. Am J Physiol Lung Cell Mol Physiol. 2002 Apr;282(4):L693-702.


Smoking was associated with an increased risk of respiratory complications (e.g. desaturation, cough, apnea) in ambulatory surgery patients. Myles PS, Iacono GA, Hunt JO, Fletcher H, Morris J, McIlroy D, Fritschi L. Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: smokers versus nonsmokers. Anesthesiology. 2002 Oct;97(4):842-7.


The odds ratios for PPCs developing in current smokers, recent smokers, and ex-smokers in comparison with never-smokers were 2.09, 2.44, and 1.03, respectivelyNakagawa M, Tanaka H, Tsukuma H, Kishi Y: Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications after pulmonary surgery. Chest 2001; 120:705–10


Starting 4h after induction of anesthesia, decreases in antimicrobial functions were 1.5-3 times greater in current and former smokers (2 months' abstinence) than in patients who had never smoked. Kotani N, Kushikata T, Hashimoto H, Sessler DI, Muraoka M, Matsuki A: Recovery of intraoperative microbicidal and inflammatory functions of alveolar immune cells after a tobacco smoke-free period. Anesthesiology 2001; 94:999– 1006


Smoking increased the risk of unplanned intensive care admittance (odds ratio 1.55). Moller AM, Maaloe R, Pedersen T: Postoperative intensive care admit-tance: The role of tobacco smoking. Acta Anaesthesiol Scand 2001; 45:345–8


Smoking was associated with macrophage aggregation but markedly reduced phagocytic and microbicidal activity-possibly because expression of proinflammatory cytokines was reduced in these patientsKotani N, Hashimoto H, Sessler DI, Yoshida H, Kimura N, Okawa H, Muraoka M, Matsuki A: Smoking decreases alveolar macrophage function during anesthesia and surgery. Anesthesiology 2000; 92:1268–77


Cardiopulmonary exercise performance was improved by 7 days of abstinence from smoking. Hashizume K, Yamaji K, Kusaka Y, Kawahara K. Effects of abstinence from cigarette smoking on the cardiorespiratory capacity. Med Sci Sports Exerc. 2000 Feb;32(2):386-91.


When compared with nonsmokers, smokers with chronic airflow limitation had an increased number of goblet cells, CD45+ cells, macrophages, and CD8+ cells, in the epithelium of peripheral airways. When all the smokers were grouped together, they showed an increased number of neutrophils as wellSaetta M, Turato G, Baraldo S, Zanin A, Braccioni F, Mapp CE, Maestrelli P, Cavallesco G, Papi A, Fabbri LM: Goblet cell hyperplasia and epithelial inflam- mation in peripheral airways of smokers with both symptoms of chronic bron- chitis and chronic airflow limitation. Am J Respir Crit Care Med 2000; 161: 1016–21


Administration of desflurane to patients who are smokers caused significant bronchoconstriction compared with nonsmokers receiving desfluraneGoff MJ, Arain SR, Ficke DJ, Uhrich TD, Ebert TJ: Absence of bronchodi- lation during desflurane anesthesia: A comparison to sevoflurane and thiopental. Anesthesiology 2000; 93:404–8


Passive inhalation of tobacco smoke (secondhand smoke) is a risk factor for adverse respiratory events in childrenSkolnick ET, Vomvolakis MA, Buck KA, Mannino SF, Sun LS: Exposure to environmental tobacco smoke and the risk of adverse respiratory events in children receiving general anesthesia. Anesthesiology 1998; 88:1144–53


Current smoking was associated with a nearly sixfold increase in risk for a postoperative pulmonary complication. Reduction in smoking within 1 month of surgery was not associated with a decreased risk of postoperative pulmonary complicationsBluman LG, Mosca L, Newman N, Simon DG. Preoperative smoking habits and postoperative pulmonary complications. Chest. 1998 Apr;113(4):883-9. 


Specific respiratory events (e.g. re-intubation, laryngospasm, aspiration, hypoventilation, etc.) had a total incidence of 5.5% in smokers and 3.1% in nonsmokersSchwilk B, Bothner U, Schraag S, Georgieff M: Perioperative respiratory events in smokers and nonsmokers undergoing general anaesthesia. Acta Anaesthesiol Scand 1997; 41:348–55


Chronic cigarette smokers were found to have significantly greater upper airway reflex sensitivity compared with non-smokers; the sensitivity was unaltered after 24 h of abstinence but was found to reduce over several daysErskine RJ, Murphy PJ, Langton JA: Sensitivity of upper airway reflexes in cigarette smokers: Effect of abstinence. Br J Anaesth 1994; 73:298–302


Inhaled nicotine produces a concentration-dependent cough and airway obstruction in healthy subjects. Hansson L, Choudry NB, Karlsson JA, Fuller RW. Inhaled nicotine in humans: effect on the respiratory and cardiovascular systems. J Appl Physiol (1985). 1994 Jun;76(6):2420-7.


During induction, both active and passive smokers had a higher incidence of adverse events than non-smokers. Dennis A, Curran J, Sherriff J, Kinnear W: Effects of passive and active smoking on induction of anaesthesia. Br J Anaesth 1994; 73:450–2


When measured during general anesthesia, smokers have a slower bronchial mucus transport than nonsmokersKonrad FX, Schreiber T, Brecht-Kraus D, Georgieff M: Bronchial mucus transport in chronic smokers and nonsmokers during general anesthesia. J Clin Anesth 1993; 5:375–80


Maximal metabolic response and rate of alveolar macrophages were significantly higher at six months of abstinence, compared to prior smoking. In addition, the time to reach the maximal peak was reduced after six smoke-free months, indicating a more rapid cell activationSkold CM, Forslid J, Eklund A, Hed J: Metabolic activity in human alveolar macrophages increases after cessation of smoking. Inflammation 1993; 17:345–52


Over the course of follow-up, quitters, in comparison with nonquitters, had significantly lower mean levels of columnar cells, mucus, mucous spirals, and metaplasia, and significant reductions in precessation levels of macrophages, pigmented macrophages, and neutrophilsSwan GE, Hodgkin JE, Roby T, Mittman C, Jacobo N, Peters J: Reversibility of airways injury over a 12-month period following smoking cessation. Chest 1992; 101:607–12


Smoking is an independent predictor of respiratory failure during high-risk surgerySvensson LG, Hess KR, Coselli JS, Safi HJ, Crawford ES: A prospective study of respiratory failure after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg 1991; 14:271–82


Postoperative pulmonary complications occurred in a third of current smokers. Patients who had stopped smoking for 2 months or less had a pulmonary complication rate almost 4 times that of patients who had stopped for more than 2 months (57.1% versus 14.5%). Patients who had stopped smoking for more than 6 months had rates similar to those who had never smoked (11.1% and 11.9%, respectively). Warner MA, Offord KP, Warner ME, Lennon RL, Conover MA, Jansson-Schumacher U: Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: A blinded prospective study of coronary artery bypass patients. Mayo Clin Proc 1989; 64:609–16


A minimum period of 4-6 weeks would seem appropriate to greatly influence postoperative respiratory morbidity; there are no proven disadvantages to the respiratory system from stopping smoking in the short term. Pearce AC, Jones RM. Smoking and anesthesia: preoperative abstinence and perioperative morbidity. Anesthesiology. 1984 Nov;61(5):576-84.