More Anesthesia Needed For Cigarette Smokers

In a landmark study researchers in Turkey looked at the amount of anesthesia needed to sedate and anesthetize active smokers, passive smokers and nonsmokers for a surgical hysterectomy. Passive smokers were nonsmokers who were exposed to second hand smoke and had evidence of cotine in their blood. Cotine is a metabolite of nicotine. There were 30 women in each group.

Standard intravenous anesthesia was used on all patients. After each surgery the amount of anesthesia and post-operative pain killer needed to control pain was assessed. Smokers required 38% more propofol than nonsmokers and 17% more than passive smokers. Smokers used 23% more painkiller than nonsmokers and 6% more than passive smokers to control post-operative pain.

The explanations for why this occurs include the fact that nicotine affects the metabolism of anesthetic drugs in the liver. It may increase the activity of the enzyme systems that metabolize the anesthesia thus requiring higher doses. Anesthesiologists in general have not considered cigarette smoking as a reason to consider using more medicine and higher doses but must now take this into consideration when planning a procedure. What may be interesting is if in future studies researchers are able to measure how far in advance of a procedure smoking cessation is needed to allow the anesthesiologist to use the smaller anesthesia levels appropriate for nonsmokers to achieve the sedation and pain control required to operate?