Nicotine Replacement Therapies

NRTs are USA FDA-approved devices that are effective in helping treat tobacco dependence, acting on nicotinic acetylcholine receptors to mimic or replace the effects of nicotine, the highly addictive chemical from tobacco products.

NRTs are available OTC (e.g., gum, transdermal patch, sublingual lozenge/tablet) and by prescription (e.g., nasal spray, inhaler).

NRTs provide only nicotine; they do not contain the carcinogens and toxic gases that are found in cigarette smoke.

Pts who smoke cigarettes are at increased risk of periop complications, including respiratory, cardiac, and wound-healing complications. Preop smoking cessation can reduce these risks, particularly when abstinent for at least 3–4 wk before surgery.

NRT is effective for increasing smoking cessation in both periop and nonperiop settings.

Nicotine via NRTs is safer than cigarette smoking, since exposure to toxic combustion products is averted. Starting NRT as early as possible preop is advised to increase the duration of preop cessation. There is no evidence that short-term cessation increases complications. Smoking cessation at any time periop may lead to long-term cessation.

Some preclinical evidence that nicotine in higher doses than produced by NRT decreases viability of skin flaps. However, no human studies have shown increased risk of cardiovascular or wound-healing complications caused by NRT.