Smoking poses significant risks for patients undergoing anesthesia, increasing the likelihood of complications both during and after surgery. Anesthesiologists must assess and manage these risks to improve patient outcomes.<br />How Smoking Affects Anesthesia<br /> 1. Airway and Respiratory Challenges<br /> • Smoking causes chronic inflammation of the airways, leading to increased mucus production and airway irritation.<br /> • Higher risk of bronchospasm, laryngospasm, and difficult intubation due to airway reactivity.<br /> • Reduced lung function increases the likelihood of atelectasis (lung collapse) and postoperative pneumonia.<br /> 2. Cardiovascular Risks<br /> • Nicotine and carbon monoxide in cigarettes reduce oxygen delivery by increasing carboxyhemoglobin levels.<br /> • Increased risk of hypertension, arrhythmias, and perioperative heart attacks due to vasoconstriction and reduced oxygen supply.<br /> 3. Impaired Wound Healing<br /> • Smoking reduces tissue oxygenation and collagen synthesis, leading to poor surgical healing and higher infection rates.<br /> • Increased risk of wound dehiscence (opening of the surgical wound(<br /><br />Practical Recommendations for Smokers Undergoing Anesthesia<br /> 1. Preoperative Smoking Cessation<br /> • Ideal cessation period: 4–6 weeks before surgery to improve lung function and reduce complications.<br /> • Even 24–48 hours of abstinence can reduce carboxyhemoglobin levels, improving oxygenation.<br /> • Use of nicotine replacement therapy (NRT) or medications like varenicline or bupropion may be beneficial.<br /> 2. Intraoperative Considerations<br /> • Difficult airway management: Prepare for potential intubation difficulties and consider fiberoptic intubation if needed.<br /> • Ventilation strategy: Use lung-protective ventilation (low tidal volumes, PEEP) to prevent postoperative pulmonary complications.<br /> • Monitoring: Increased vigilance for hypoxia, hypercarbia, and hemodynamic instability.<br /> 3. Postoperative Care<br /> • Aggressive pulmonary hygiene: Incentive spirometry, deep breathing exercises, and early mobilization to prevent atelectasis.<br /> • Pain management: Avoid excessive opioids, which can depress respiration; consider regional anesthesia or multimodal analgesia.<br /> • Smoking cessation support: Reinforce quitting strategies postoperatively to improve long-term health outcomes.<br /><br />Conclusion<br /><br />Smoking significantly complicates anesthesia and surgery, increasing respiratory, cardiovascular, and healing-related risks. Preoperative smoking cessation, tailored intraoperative management, and comprehensive postoperative care are essential to reduce complications and improve surgical outcomes.<br />BY<br />B.M.TECH<br />OSAMAH AZIZ<br />References:<br /> • American Society of Anesthesiologists (ASA) – www.asahq.org (https://www.asahq.org/)<br /> • Centers for Disease Control and Prevention (CDC) – www.cdc.gov (https://www.cdc.gov/)<br /> • World Health Organization (WHO) – www.who.int (https://www.who.int/)<br /><br />Al-Mustaqbal University is the first university in Iraq