Nicotine replacement therapy … - Carlos A ... - Entretiens du Carla

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Table 1-Smoking as a contributing factor for perioperative complications
1. - Pulmonary complications. The increase in the relative risk (RR) is 1.7.
1.1.- Smokers can suffer from smoking related respiratory pathology.
1.2.- Even “healthy” smokers can suffer from:
1.2.1.- Impaired ciliary function.
1.2.2.- Increased mucus production.
1.2.3.- Retained secretions.
1.2.4.- Alterations in lung inmune responses.
2.- Cardiovascular complications. The increase in the relative risk (RR) is 3.
2.1.- Smokers can suffer from smoking related cardiovascular disorders.
2.2.- Even “healthy” smokers can suffer from:
2.2.1.- Endothelial damage.
2.2.2.- Oxidant injury.
2.2.3.- Neutrophil activation.
2.2.4.- Enhacement of thrombosis.
2.2.5.- Enhacement of aterosclerosis.
2.2.6.- Increasing coagulability.
2.2.7.- Increasing simpathetic tone.
2.2.8.- Decreasing the capacity of blood to carry oxygen.
3.- Complications related to impaired healing of bones and surgical wounds.
The increase in the relative risk (RR) is 2.
3.1.- Smokers can suffer from smoking related wounds disorders. Among these:
wound dehiscence and infection, and nonunion of fractured bones.
3.2.- Even “healthy” smokers can suffer from:
3.2.1.- Decreasing tissue oxygenation secondary to vasoconstriction,
carboxyhemoglobin and inhibition of inmune responses.
An important recent investigation studied
experimental wounds in smokers.
One group of smokers continued smoking,
another group stopped smoking without
using NRT and another group quit smoking
using NRT.
Abstinence from smoking substantially
decreased the rate of wound infection,
whether or not NRT was used (26).
This study supports the idea that NRT is
safe in these patients.
Taking into account all of these
considerations we can conclude that NRT
should considered for helping surgical patients
maintain abstinence before and after surgery.
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