Skip to main content

No increased risk detected from smoking cessation just before surgery (Arch Intern Med)


Remember that weird advice we were taught as physicians-in-training to give to smoking patients before an upcoming surgery? “You should quit smoking, but not within the 2 weeks just before your surgery.” (It sounds off-key to me even as I write it now.) Based on … what? Some medical lore passed down from a decades-old study none of us ever actually read?
I always thought that counsel sounded fishy. Apparently, according to a few smart people who looked at the actual evidence, it was.
In a literature review and meta-analysis (actually 3 meta-analyses), Myers et al examined 9 studies and found no evidence of increased complications (pulmonary or otherwise) associated with quitting smoking within 8 weeks before surgery of any kind. They include, and debunk, the 1989 cohort study that birthed the dogma that just-quit smokers are at increased risk for post-op pulmonary complications. That paper in fact did not show a statistically significant difference in complication rates between continuing smokers and just-quit smokers (the salient comparison).
There was wide heterogeneity between studies, hence the 3 separate meta-analyses. Their sensible conclusion: counsel everyone to quit smoking, regardless of surgery timing.

Labels:

Comments

Post a Comment

Popular posts from this blog

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by:   the area of the curve  the slope of the line from points C to D  the distance of the line from points C to D  the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by:  the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.
Post a Comment
Read more

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body
Post a Comment
Read more

Steroids In Perioperative period...The Multi-purpose Drugs

1-Steroids are not Bronchodilator ,but have well established usefulness in hyper-reactive airway. They are also said to have a permissive role for bronchodilator medication. They can be administered orally, parenterally or in aerosol form 2- Steroids have been commonly used in chemotherapy for prevention of nausea along with other anti-emetic agents . Dexamethasone was found to be highly effective when given immediately before induction rather than at the end of anesthesia . 3- Steroids do exert analgesic effects. Various routes of administration of steroids include parentral, local infiltration at operated site , as an adjuvant in nerve blocks and central-neuraxial blockade. 4 - Steroids cannot be the mainstay of therapy in anaphylaxis because of the delayed onset of action, so they are used as adjunct after initial treatment with epinephrine. 5- Steroids (Dexamethsone) are of value in reduction or prevention of cerebral edema associated with parasitic infections and neopla...
1 comment
Read more