Induction-intubation response - smokers vs non-smokers

ABSTRACT

Tobacco smoking has been established to be a hazardous activity. Changing social attitude is bringing a decline in tobacco consumption but a significant proportion of patients presenting for surgery still continues to smoke, putting themselves at risk of perioperative complications. We evaluated induction-intubation response in 40 male patients [ASA-I] divided into two groups of 20, each consisting of smokers and non-smokers. All patients received standard premedication and general anesthesia. Heart rate, blood pressure and rate-pressure product were measured prior to induction, just before intubation and at 1,3,5 and 10 minutes after intubation. Continuous electrocardiography [EKG lead II] monitoring was done. Carboxyhemoglobin and total hemoglobin were estimated at the time of securing venous access. Arterial blood gases were analyzed 5 minutes before and after the tracheal intubation. Incidence of arrhythymias [30%] was higher in smokers compared to non-smokers [10%]. Mean carboxyhemoglobin [COHb] level in smokers was 3.81 +/- 2.17 gdL[-1] as compared to 2.95 +/- 1.33 gdL[-1] in non-smokers. Four patients who continued to smoke till the day of surgery had higher COHb levels [8.2, 5.9, 6, 8.8 gdL[-1]]. PaO[2] and PaCO[2] levels were comparable in both groups. During induction-intubation period, heart rate; systolic, diastolic and mean arterial pressure and rate-pressure product showed more pronounced fluctuations in smokers than in non-smokers [p<0.05]