Why should you quit smoking before surgery?

This is the 3336th article of Da Yi Xiao Hu

Before surgery, the anesthesiologist will conduct a preoperative visit. They often focus on the following questions: Do you smoke regularly? How many cigarettes do you smoke a day? Have you quit smoking recently? How long have you quit? When you answer these questions, you must be wondering, what is the relationship between smoking and anesthesia? Is it so important to quit smoking before surgery?

It is common knowledge that smoking is harmful to health. But how does smoking harm our health and to what extent?

Smoking causes harm to the human body mainly through the toxic alkaloids contained in tobacco smoke - nicotine and carbon monoxide (CO). Nicotine puts pressure on the heart and increases oxygen consumption, while carbon monoxide impairs the ability to transport oxygen to the heart.

In addition to the above effects, the risks faced by smokers during surgery are much greater than those faced by non-smoking patients!

Increased risk of lung infection

Pulmonary complications are the most common complications in surgical patients, and smoking is an independent risk factor for perioperative respiratory complications. Smoking can cause inflammatory changes in lung tissue, weaken the clearance function of the respiratory mucus-ciliary transport system, reduce the sensitivity of the cough reflex, increase sputum, and make it impossible to expel it, increasing the risk of postoperative lung infection.

Delayed wound healing after surgery

Nicotine stimulates the sympathetic nervous system to release catecholamines, causing peripheral vasoconstriction and reducing tissue perfusion rate; carbon monoxide increases blood viscosity, inhibits the binding of hemoglobin and oxygen, and reduces blood and oxygen supply to the wound skin; it destroys the production of collagen and aggravates the delay of wound healing.

But even though smoking has so many harms, there are still a large number of smokers in my country! The "China Smoking Hazards Health Report 2020" released this year shows that there are more than 300 million smokers in my country, and the smoking rate of people aged 15 and above is 26.6%, among which the smoking rate of men is as high as 50.5%.

Quitting smoking before surgery can help the body improve its immune function, reduce the incidence of postoperative pulmonary complications, and speed up recovery. Therefore, the longer smokers quit smoking before surgery, the better the effect, as shown in Figure 2.

Figure 2

However, most smoking patients cannot quit smoking before surgery, which brings great challenges to anesthesiologists. Even so, anesthesiologists still do their best to intervene before, during and after surgery to ensure your safety during the perioperative period!

Before surgery

The anesthesiologist conducts a preoperative visit to fully understand the patient's smoking history and symptoms

Perform a physical examination (auscultation of breath sounds, breath-hold test, stair climbing test, etc.), and check laboratory tests (blood routine, chest CT, pulmonary function test)

Inform patients of the benefits of quitting smoking and encourage them to quit for at least 8 weeks

Patients with concurrent lung diseases, such as infection, chronic obstructive pulmonary disease (COPD), should receive appropriate treatment before surgery.

Instruct patients to perform lung function exercises, such as effective coughing, pursed lip breathing (instruct patients to close their mouths and inhale through their noses, hold their breath for 1 to 2 seconds, then exhale with pursed lips, and exhale slowly like whistling for 4 to 6 seconds. The degree of lip pursing is adjusted by the patients themselves, and consistency is ensured as much as possible. The ratio of inhalation to exhalation time is 1:2), abdominal breathing (when inhaling, the abdomen is inflated against the pressure of the hands, and the exhalation time should be 2 to 3 times the inhalation time), and balloon blowing (take a deep breath, and then blow into the balloon as hard as you can until you can't blow out any air)

High-risk patients and surgeons jointly discuss surgical plans to shorten the operation time as much as possible

If necessary, consult with the respiratory medicine and cardiology departments to postpone the surgery and develop a treatment plan to improve the patient's preoperative cardiopulmonary function.

During surgery

Implement precise anesthesia based on individual patient conditions

Before endotracheal intubation, instruct the patient to take deep breaths and give him/her adequate oxygen inhalation.

Endotracheal intubation should be performed after a certain depth of anesthesia is reached to avoid laryngeal spasm and bronchospasm

Choose the appropriate anesthesia method and use drugs rationally

Choose multimodal analgesia and reduce the use of drugs that cause respiratory depression

Suction sputum if necessary

If the patient's condition permits, positive end-expiratory pressure is applied during surgery to redistribute pulmonary blood flow from the inflated alveolar areas to the atelectasis areas.

The manual lung recruitment strategy applies appropriate pressure for a period of time to "expand" the lungs again

After surgery

Take multiple measures to prevent postoperative pulmonary complications

Rational use of drugs to prevent and control lung infections

Improve analgesia and reduce postoperative pain

Get out of bed and move around as soon as possible if your condition allows

Encourage and assist patients to perform respiratory function exercises, such as effective coughing, pursed lip breathing, abdominal breathing, and balloon blowing.

Continue to promote and implement smoking cessation

It is our mission and responsibility as anesthesiologists to protect you.

Author: Tang Yuan Wang Shuxin

Proofreading: Wu Pinwen