The relationship between smoking dependence, exposure to cigarette smoke, carboxyhemoglobin and perioperative complications in patients who underwent laparoscopic cholecystectomy under general anesthesia

Abstract

Objectives: The aim of this study; to determine the effects of preoperative smoking dependence and noninvasively measured carboxyhemoglobin (COHb) levels on perioperative complications in patients who underwent elective laparoscopic cholecystectomy.

Methods: Ninety patients (Group I: smoker, Group II: non-smoker, and Group III: passive smoker) who underwent laparoscopic cholecystectomy under general anesthesia were studied. The level of dependence of smokers was evaluated with the Fagerstrom Test for Nicotine Dependence (FNBT). Preoperative COHb level was determined with a pulse CO-oximeter by placing a sensor on the fingertip. Respiratory complications in the perioperative and recovery room and Modified Aldrete Score (MAS) in the recovery room were recorded as 5th, 10th and 15th min.

Results: Female gender was significantly higher in Groups II and III. Significant increases were noted in Group I in terms of increased perioperative secretion and incidence of bronchospasm. In the recovery room, the increase in MAS 5th min in Group I and MAS 10th min and 15th min in Group III was significantly lower. In Group I, positive correlations between the COHb level and the number of cigarettes smoked and the FNBT level, and a negative correlation between MAS and the number of hours past after the last cigarette smoked were determined. In Group II, the COHb level correlated positively with the number of cigarette smokers at home and negatively with MAS. All these correlations were statistically significant.

Conclusions: It was demonstrated that cigarette smoking increased the incidence of perioperative respiratory complications under general anesthesia. Preoperative COHb level estimated by the pulse CO-oximeter can be used as an indicant of the potential risk of perioperative repiratory complications.

Keywords

• Smoking
• Carboxyhaemoglobin
• Noninvasive pulse CO-oximetry
• perioperative respiratory complications
• Laparoscopic cholecystectomy

References

1. 1. Turan A, Mascha EJ, Roberman D, Turner PL, You J, Kurz A, et al. Smoking and perioperative outcomes. Anesthesiology 2011;114:837-46.
2. 2. Pati BS, Rath A, Mishra SB. Study of peri-operative complications in asymptomatic smokers posted for day care surgery. J Anesth 2017;6:2581-5.
3. 3. Sakai RL, Abrao GM, Avres JFV, Vianna PTG, Carvalho LRD, Castiglia YMM. Prognostic factors for perioperative pulmonary events among patients undergoing upper abdominal surgery. Sao Paulo Med J 2007;125:315-21.
4. 4. Warner DO. Preventing postoperative pulmonary complications the role of the anesthesiologist. Anesthesiology 2000;92:1467-72.
5. 5. Møller AM, Villebro N, Pedersen T, Tonnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002;359:114-7.
6. 6. Theadom A, Cropley M. Effects of preoperative smoking cessation on the incidence and risk of intraoperative and postoperative complications in adult smokers: a systematic review. Tob Control 2006;15:352-8.
7. 7. Sharma A, Deep AP, Iannuzzi JC, Monson JR, Fleming FJ. Tobacco smoking and postoperative outcomes after colorectal surgery. Ann Surg 2013;258:296-300.
8. 8. Myers K, Hajek P, Hinds C, McRobbie H. Stopping smoking shortly before surgery and postoperative complications: a systematic review and meta-analysis. Arch Intern Med 2011;171:983-9.

9. 9. Graybill WS, Frumovitz M, Nick AM, Wei C, Mena GE, Soliman PT, et al. Impact of smoking on perioperative pulmonary and upper respiratory complications after laparascopic gynecologic surgery. Gynecol Oncol 2012;125:556-60.
10. 10. Myles PS, Iacono GA, Hunt JO, Wei C, Mena GE, Soliman PT, et al. Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: smokers versus nonsmokers. Anesthesiology 2002;97:842-7.
11. 11. Hart CL, Smith GD, Hole DJ, Hawthorne VM. Carboxyhaemoglobin concentration, smoking habit, and mortality in 25 years in the Renfrew/Paisley prospective cohort study. Heart 2006;92;321-4.
12. 12. Neil B Hampson. Inaccurate pulse CO-oximetry of carboxyhemoglobin due to digital clubbing: case report. Undersea Hyperb Med 2018;45:165-71.
13. 13. Kaya S, Bulut M, Varışlı B, Katı Y, Karaoğlu U. Comparing noninvasive pulse CO-oximeter vs blood gas analysis in emergency department patients with carbon monoxide poisoning. Anatolian J Emerg Med 2018;1:1-4.
14. 14. Karaman S, Odabaş Ö, Kadıoğlu E, Uysal M, Erkuran K, Demir ÖF. [Noninvasive assessment of the level of carboxyhemoglobin and carboxyhemoglobin with technical analysis of affecting availability]. Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi 2014;6:36-53. [Article in Turkish]
15. 15. Jones DT, Bhattacharyya N. Passive smoke exposure as a risk factor for airway complications during outpatient pediatric procedures. Otolaryngol Head Neck Surg 2006;135:12-6.
16. 16. O’Rourke JM, Kalish LA, McDaniel S, Lyons B. The effects of exposure to environmental tobacco smoke on pulmonary function in children undergoing anesthesia for minor surgery. Paediatr Anaesth 2006;16:560-7.
17. 17. Tütüncü A, Dilmen O, Utku T, Erbabacan E, Ekici B, Köksal G, et al. The effects of passive smoking on COHb, PaO2 and PaCO2 levels and postoperative respiratory complications in children undergoing general anesthesia Turk Arch Ped 2012;47:204-9.
18. 18. Simsek E, Karaman Y, Gonullu M, Tekgul Z, Cakmak M. The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery. Rev Bras Anestesiol 2016;66:492-8.
19. 19. Bluman LG, Mosca L, Newman N, Simon DG. Preoperative smoking habits and postoperative pulmonary complications. Chest 1998;113:883-9.
20. 20. Schwilk B, Bothner U, Schraag S, Georgieff M. Perioperative respiratory events in smokers and nonsmokers undergoing general anaesthesia. Acta Anaesthesiol Scan 1997;41:348-55.
21. 21. Lee SM, Landry J, Jones PM, Buhrmann O, Morley-Forster P. The Effectiveness of a perioperative smoking cessation program: a randomized clinical trial. Anasth Analg 2013;117:605-13.
22. 22. Ozgunay SE, Karasu D, Dulger S, Yilmaz C, Tabur Z. Relationship between cigarette smoking and the carbon monoxide concentration in the exhaled breath with perioperative respiratory complications Rev Bras Anestesiol 2018;68:462-71.
23. 23. Reddy AP, Zaremba ML, Reddy SP. Noninvasive pulse CO-oximetry as a tool to detect smoking status in an outpatient setting. Chest 2007;132:490A.
24. 24. Yee BE, Ahmed MI, Brugge D, Farrell M, Lozada G, Idupaganthi R, et al. Second-hand smoking and carboxyhemoglobin levels in children: a prospective observational study. Paediatr Anaesth 2010;20:82-9.
25. 25. Cardwell K, Pan Z, Boucher R, Zuk J, Friesen RH. Screening by pulse CO-oximetry for environmental tobacco smoke exposure in preanesthetic children. Paediatr Anaesth 2012;22:859-64.
26. 26. Lee A, Chui PT, Chui CH, Tan PE, Tam TP, Samy W, et al. Risk of perioperative respiratory complications and postoperative morbidity in a cohort of adults exposed to passive smoking. Ann Surg 2015;261:297-303.