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Learning objectives Describe the perioperative complications associated with smoking Manage smoking patients scheduled for anesthesia Background Cigarette smoking is one of the primary causes of preventable illness and premature death Quitting smoking before surgery leads to a reduced incidence of postoperative complications The longer the period of cessation before surgery, the greater the benefit Perioperative complications associated with smoking There is a clear dose-response relationship between the amount smoked and perioperative morbidity Possible complications: Management Education regarding the benefits of pre-operative smoking cessation when possible Ideally, smoking is stopped 8 weeks before surgery Stop smoking 24h before surgery to negate the effects of nicotine and COHb Effects of smoking cessation: Symptoms of cough and wheeze decrease within weeks Mucociliary clearance starts to improve after a week Lung inflammation takes much longer to subside Goblet cell hyperplasia regresses and alveolar macrophages decrease Decrease in all-cause mortality in patients with coronary artery disease by approximately 33% Risk of coronary heart disease and cerebrovascular disease approaches the risk of never-smokers within 10-15 years Guidance Patients who smoke are more likely to quit if they are offered a combination of interventions Ask and record smoking history (pack-years) Advise that the most effective way to quit is with a combination of medication and specialist support Pharmacological aid Nicotine replacement therapy (patches, lozenges, chewing gum, or nasal sprays.) Oral bupropion Oral varenicline Suggested reading Carrick MA, Robson JM, Thomas C