PS12 2014: Smoking

 

List:

·         Premise

·         Peri-op complications

·         Three point cessation strategy

·         Treatment options

·         Timeline after quitting

·         When to quite

 

Premise:

·         Smoking causes peri-op complications -> morbidity, mortality, $$$

·         It is highly addictive and spontaneous quit rates are low

·         Peri-op period is likely a “teachable moment”

 

Peri-op complications of smoking:

Respiratory

·      Pneumonia

·      Airway hyperreactivity

·      Unplanned intubation

Cardiovascular

·      AMI

·      Cardiac arrest

·      Stroke

Haematological

·      VTE

Immunological

·      Wound infection

·      Slow healing

·      ↑Pain

·      ↑Opioid requirement

Pharmacological

·      Induction of CYP 1A1, 1A2, 2E1 -> ↑metabolism of roc, vec

 

Three point cessation strategy:

1.Ask

·      Do you smoke? (even if already known)

2.Advise

·      Explain peri-op risks (often not known)

3.Refer

·      GP

·      Pharmacist

·      Counsellor

·      Quitline

 

Treatment options:

Non-drug

·      Individual counselling

·      Group counselling

·      Hypnotherapy

·      Rapid smoking aversive therapy

Drug

·      Nicotine replacement: nicotine, nicotine partial agonist (varenicline)

·      Monoamine reuptake inhibition: bupropion, nortryptiline

·      Sympatholytic for symptom relief: clonidine

 

Timeline after quitting:

1 day

·      ↓HbCO -> ↑O2 content

·      ↓Nicotine/↓SNS

3 weeks

·      ↑Wound healing

6-8 weeks

·      ↓Sputum volume

·      ↑Lung function

6 months

·      ↑Immune function

 

When to quit?

6-8 weeks

·      Good

0-4 weeks

·      ??? bad because ↑sputum + poor clearance

o  Views entrenched

o  Evidence poor

Cutting down

·      Probably pointless due ‘compensatory smoking’ (=smoking harder)

 

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