Cigarette Smoking Cessation

In USA, approximately 21% of adults smoke tobacco; prevalence varies inversely with socioeconomic class; men > women (26% vs. 15%).

Minorities more likely to smoke and less likely to quit.

Prevalence among adults and teens declining, but growing evidence that teens using electronic cigarettes may be more likely to try other tobacco products.

Current smokers at increased risk of pneumonia, sepsis, unplanned intubation, mechanical ventilation, cardiac arrest, MI, stroke, and death.

Increased periop morbidity and mortality related to smoking-associated diseases.

Probability of morbidity and mortality increase with number of packs smoked per year.

Undiagnosed or poorly treated smoking-related disease (CAD, COPD, cerebrovascular, and peripheral arterial disease) that may affect a safe anesthetic plan

Propensity for bronchospasm, coughing, decreased pulm reserve, and mucus plugging

Decreased O ₂ content secondary to high COHb levels

Increased heart rate and BP secondary to nicotine in pts who have smoked just before anesthesia

Home exposure to second-hand smoke and increase risk of periop pulm complications in children (laryngospasm and asthma)

Smoking results in acute changes in cardiopulmonary function, even in otherwise asymptomatic patients. With long-term use, smoking causes chronic changes in cardiopulmonary function that eventually culminate in irreversible cardiopulmonary disease.

Acute changes include carbon monoxide-mediated decreases in O ₂ content and nicotine-induced increases in heart rate and BP. Nicotine-mediated effects are relatively short-lived, whereas COHb persists for many hours.

Chronic changes include a gradual decline in lung function, consisting of decreases in FEV ₁ , mucociliary activity, gas exchange, and pulm macrophage activity.

Associated diseases including CAD, COPD, cerebrovascular disease, and numerous cancers (lung, laryngeal, oral, stomach, bladder, and others).

Acquired behavior that is generally viewed as addiction (both physical to components of tobacco, e.g., nicotine, and psychological/social)

Risk factors: low education level, low socioeconomic status, and early age of smoking onset