Smokers Require More Anesthetic During Operations

A new study reveals that both smokers and those exposed to passive smoke require more anesthetic and painkillers to reach the same level of anesthesia as nonsmokers.

Researchers at Bezmialem Vakif University (Istanbul, Turkey) conducted a study to investigate whether there is a difference between smokers (S), passive smokers (PS), and nonsmokers (NS), in terms of intraoperative anesthetic and painkiller consumption. A total of 90 women undergoing total abdominal hysterectomy were divided into three equal groups (S, PS, and NS), as confirmed by measurement of serum cotinine, a metabolite of nicotine and marker of tobacco smoke exposure.

Standard total intravenous anesthesia was performed on all patients, and after the operation, the total amount of propofol and the painkiller remifentanil used was recorded. The amount of propofol used for induction of anesthesia in Group S was 38% higher than in Group NS, and 17% higher than in Group PS, and in Group PS the amount used was 18% higher than in Group NS. Total propofol usage throughout the whole anesthesia was also different between groups; in Group S the amount used was 33% higher than in Group NS and 16% higher than in Group PS, and in Group PS 20% higher than in Group NS.

The total amount of the painkiller remifentanil used also differed among groups; Group S had 23% higher usage than Group NS and 6% more compared to Group PS; and in Group PS usage was higher 18% than in Group NS. The study was presented at the annual Euroanaesthesia meeting, held in Berlin (Germany) during May-June 2015.

“The amounts of anesthetic and painkiller required to ensure equal anesthetic depth in similar surgeries was higher in active smokers and passive smokers compared to nonsmokers, “concluded lead author and study presenter Erdogan Ozturk, MD, of the department of anesthesiology and intensive care, and colleagues. “Nicotine could affect the metabolism of anesthetic drugs in the liver, or may desensitize some nociceptors that sense pain.”

Cigarette smoke contains over 4,000 substances, some of which cause cardiovascular problems, such as increasing blood pressure, heart rate, and systemic vascular resistance. Others cause respiratory problems, interfering with oxygen uptake, transport, and delivery, as well as drug metabolism. They also cause interference with respiratory function, both during and after anesthesia. The high degree of co-morbidity between pain and tobacco smoking has also attracted the attention of researchers and clinicians within the medical and behavioral sciences.

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Bezmialem Vakif University