By: 25 June 2015
Smokers and passive smokers require more anaesthetic for operations

Smokers and passive smokers require more anaesthetic for operations

Euroanaesthesia research reveals smokers and passive smokers need higher doses of painkillers and anaesthetic than non-smokers during surgery

Research published at this year’s Euroanaesthesia meeting in Berlin (30 May-2 June) shows that both smokers and those exposed to passive smoke require more anaesthetic and painkillers to reach the same level of anaesthesia as non-smokers.

Erdogan Ozturk and colleagues at Bezmialem Vakif University in Istanbul, Turkey, investigated whether there is a difference among smokers, passive smokers and non-smokers in terms of intraoperative anaesthetic and painkiller consumption.

A total of 90 women undergoing total abdominal hysterectomy were enrolled in the study. The patients were divided into three groups (30 patients each) based on smoke exposure, confirmed by measurement of serum cotinine (a metabolite of nicotine and marker of tobacco smoke exposure). Group S consisted of smokers, Group PS consisted of passive smokers, and Group NS, consisted of women with no history of smoking and also no environmental smoke exposure.

Standard total intravenous anaesthesia was performed on all patients. Bispectral index values (BIS) were maintained between 40 and 60, and, after the operation, the total amount of the anaesthetic propofol and the painkiller remifentanil used was recorded.

The amount of propofol used for induction of anaesthesia was 38% higher in Group S than in Group NS and 17% higher than in Group PS; in Group PS, the amount used was higher 18% than in Group NS.

Total propofol usage throughout the whole anaesthesia 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 it was 20% higher than in Group NS.

The total amount of remifentanil used was 23% higher in Group S than in Group NS, and 6% higher than in Group PS; in Group PS usage was 18% higher than in Group NS.

The authors concluded that the amounts of anaesthetic and painkiller required to ensure equal anaesthetic depth in similar surgeries was higher in active smokers and passive smokers compared with non-smokers. They also suggested that nicotine could affect the metabolism of anaesthetic drugs in the liver, or may desensitise some of the nociceptors that sense pain.

Source: ESA (European Society of Anaesthesiology)