Risk of Respiratory Complications and Wound Infection in Patients Undergoing Ambulatory Surgery: Smokers versus Nonsmokers

Background: Smoking is considered to be a risk factor for patients undergoing surgery and anesthesia, but it is unclear whether this is applicable to patients undergoing ambulatory surgery. The aim of this study was to determine the risk of respiratory complications and wound infection among smokers.

Methods: The authors studied a random selection of 489 adult patients undergoing ambulatory surgery. Smoking status was determined by self-report and confirmed with end-expired carbon monoxide analysis. The risk of respiratory complications (i.e., desaturation, cough, laryngospasm, bronchospasm, breath-holding, or apnea) and wound infection (i.e., wound redness or discharge +/- positive microbial culture, requiring antibiotic therapy) in smokers versus nonsmokers was ascertained. Odds ratios were estimated from multivariable logistic regression and adjusted for age, gender, body mass index, partner's smoking status, domiciliary smoking exposure, and extent and duration of surgery.

Results: Most smokers continued to smoke up until the day of surgery. Smokers had a higher rate of respiratory complications (32.8%vs. 25.9%; adjusted odds ratio, 1.71; 95% confidence interval, 1.03-2.84;P = 0.038) and wound infection (3.6%vs. 0.6%; odds ratio, 16.3; 95% confidence interval, 1.58-175;P = 0.019). Odds ratios comparing current plus ex-smokers with nonsmokers were of similar magnitude for most of these complications.     

Association of cigarette smoking with extraprostatic prostate cancer in young men

PURPOSE: A few recent studies have revealed that cumulative or recent smoking is associated with death from prostate cancer suggesting that smoking may influence progression to more advanced disease. We evaluate the association of cigarette smoking with extraprostatic and/or Gleason sum 7 or greater prostate cancer in young men. MATERIALS AND METHODS: The study included men who underwent radical prostatectomy before age 55 years for prostate cancer between 1992 and 1999. A survey soliciting cigarette smoking history and other exposures was mailed to 498 eligible men. The response rate was 73%. Cases were defined as men with Gleason sum 7 or greater, extraprostatic or Gleason sum 7 or greater/extraprostatic disease based on pathologic analysis. All remaining participants were considered noncases for each case definition. We used logistic regression modeling to estimate the odds ratio (OR) for Gleason sum 7 or greater, extraprostatic and Gleason sum 7 or greater/extraprostatic disease with cigarette smoking. RESULTS: Of the 352 respondents with a cigarette smoking history 5.4% were current smokers and 44.6% were former smokers at the time of surgery. The odds ratios of extraprostatic and Gleason sum 7 or greater/extraprostatic disease were 3.85 (95% CI 1.44-10.33) and 3.17 (95% CI = 1.13-8.85), respectively, for current smokers compared to men who never smoked. Evidence of an association of smoking with Gleason sum 7 or greater disease was limited. Risk of extraprostatic (p = 0.005) and Gleason sum 7 or greater/extraprostatic (p = 0.003) disease increased with increasing cumulative pack-years smoked. Higher cumulative smoking in the 10 years before surgery was associated with an increased risk of extraprostatic (p = 0.004) and Gleason sum 7 or greater/extraprostatic (p = 0.005) disease. CONCLUSIONS: Cigarette smoking may influence the risk of extraprostatic prostate cancer in young men.     

Use of carboxyhaemoglobin levels to predict the development of diseases associated with cigarette smoking.

Carboxyhaemoglobin (COHb) levels in tobacco smokers vary throughout the day since they are affected by the pattern of tobacco consumption and the rate at which COHb is eliminated. A method is described whereby a single COHb measurement together with a recent smoking history may be used to estimate the average COHb "boost" produced by each cigarette, the total daily carbon monoxide (CO) uptake from smoking, and the mean COHb level throughout the day. These three indices of tobacco smoke absorption were estimated in nine healthy cigarette smokers on different days, each set of three estimations being derived from separate COHb determinations. The indices were reasonably reproducible within the same person, and the differences between people were statistically highly significant (P less than 0-001). For example, the estimates of mean daily COHb level resulting from smoking ranged from 0-7% to 9-3% in smokers who smoked 15 to 40 cigarettes a day. These differences are sufficiently large to distinguish possible differences in the risk of developing diseases such as ischaemic heart disease which may result from the inhalation and absorption of tobacco smoke. The suggested indices also depend less on the time of the blood test and on the daily pattern of smoking than a COHb level alone. The ratio of the COHb boost to the CO yield of a cigarrette may reflect depth of inhalation more accurately than a smoker's self-assessment. Moreover there was little correlation between these two measures of inhalation in the nine subjects studied.     

Coronary artery spasm during cholecystectomy with pneumoperitoneum--a case report

A 59-year-old man without a history of ischemic heart disease underwent elective laparoscopic cholecystectomy under general anesthesia with epidural anesthesia. About 15 min after pneumoperitoneum had been achieved, the patient developed ST elevation and hypotension. Vagal stimulation resulting from stretching peritoneum, the procedure and epidural anesthesia are thought to have induced vasospasm. The ST segment became normal after interruption of CO2 insufflation. A postoperative coronary artery angiogram showed normal coronary arteries, but diffuse coronary artery spasm was seen after intracoronary injection of acetylcholine. The patient was discharged on nitrates. Patients with gall bladder stones sometimes have coronary risk factors of obesity, hyperlipidemia and hyperglycemia. Careful attention should also be given to patients who do not have a history of coronary disease.     

Risk of Surgery and Anesthesia for Ischemic Stroke

Background: The goal of this study was to determine if the combination of surgery and anesthesia is an independent risk factor for the development of incident (first-time) ischemic stroke.

Methods: All residents of Rochester, MN, with incident ischemic stroke from 1960 through 1984 (1,455 cases and 1,455 age- and gender-matched controls) were used to identify risk factors associated with ischemic stroke. Cases and controls undergoing surgery involving general anesthesia or central neuroaxis blockade before their stroke/index date of diagnosis were identified. A conditional logistic regression model was used to estimate the odds ratio of surgery and anesthesia for ischemic stroke while adjusting for other known risk factors.

Results: There were 59 cases and 17 controls having surgery within 30 days before their stroke/index date. After adjusting for previously identified risk factors, surgery within 30 days before the stroke/index date (perioperative period) was found to be an independent risk factor for stroke (P < 0.001; odds ratio, 3.9; 95% confidence interval, 2.1-7.4). In an analysis that excluded matched pairs where the case and/or control underwent surgery considered "high risk" for stroke (cardiac, neurologic, or vascular procedures), "non-high-risk surgery" was also found to be an independent risk factor for perioperative stroke (P = 0.002; odds ratio, 2.9; 95% confidence interval, 1.5-5.7).     

Risk of surgery and anesthesia for ischemic stroke

BACKGROUND: The goal of this study was to determine if the combination of surgery and anesthesia is an independent risk factor for the development of incident (first-time) ischemic stroke. METHODS: All residents of Rochester, MN, with incident ischemic stroke from 1960 through 1984 (1,455 cases and 1,455 age- and gender-matched controls) were used to identify risk factors associated with ischemic stroke. Cases and controls undergoing surgery involving general anesthesia or central neuroaxis blockade before their stroke/index date of diagnosis were identified. A conditional logistic regression model was used to estimate the odds ratio of surgery and anesthesia for ischemic stroke while adjusting for other known risk factors. RESULTS: There were 59 cases and 17 controls having surgery within 30 days before their stroke/index date. After adjusting for previously identified risk factors, surgery within 30 days before the stroke/index date (perioperative period) was found to be an independent risk factor for stroke (P<0.001; odds ratio, 3.9; 95% confidence interval, 2.1-7.4). In an analysis that excluded matched pairs where the case and/or control underwent surgery considered "high risk" for stroke (cardiac, neurologic, or vascular procedures), "non-high-risk surgery" was also found to be an independent risk factor for perioperative stroke (P = 0.002; odds ratio, 2.9; 95% confidence interval, 1.5-5.7). CONCLUSION: Our results suggest that there is an increased risk of ischemic stroke in the 30 days after surgery and anesthesia. This risk remains elevated even after excluding surgeries (cardiac, neurologic, and vascular surgeries) considered to be high risk for ischemic stroke.     

Predictors of coronary disease in patients with end stage renal disease.

Patients with end stage renal disease have a high prevalence of cardiovascular disease and coronary arteriography is often routinely performed prior to kidney transplantation. However, the value of the conventional risk factors and non-invasive markers of coronary artery disease (CAD) in triaging patients for coronary arteriography has not been fully examined. 116 patients with end stage renal disease were evaluated. Coronary arteriography was performed in all patients either for a suspicion of CAD or as part of a routine pre-transplant evaluation. Lesions causing > or = 50% luminal diameter stenosis in any of the three major coronary artery systems were considered significant. The mean age was 53.3 +/- 9.3 years. Significant CAD was present in 69 patients (60%). Increasing age, family history of premature ischemic heart disease, the presence of angina, abnormal Q waves on the ECG or abnormal ST segment depression and the presence of coronary calcification were significant markers of coronary artery disease. However male gender, diabetes mellitus and obesity did not correlate with coronary disease. Even though hypertension, hypercholesterolemia and smoking were also not useful predictors these could have been modified by the renal failure. In conclusion increasing age, a family history of premature ischemic heart disease and some non-invasive markers were useful predictors of coronary disease.     

Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: smokers versus nonsmokers

BACKGROUND: Smoking is considered to be a risk factor for patients undergoing surgery and anesthesia, but it is unclear whether this is applicable to patients undergoing ambulatory surgery. The aim of this study was to determine the risk of respiratory complications and wound infection among smokers. METHODS: The authors studied a random selection of 489 adult patients undergoing ambulatory surgery. Smoking status was determined by self-report and confirmed with end-expired carbon monoxide analysis. The risk of respiratory complications (i.e., desaturation, cough, laryngospasm, bronchospasm, breath-holding, or apnea) and wound infection (i.e., wound redness or discharge +/- positive microbial culture, requiring antibiotic therapy) in smokers nonsmokers was ascertained. Odds ratios were estimated from multivariable logistic regression and adjusted for age, gender, body mass index, partner's smoking status, domiciliary smoking exposure, and extent and duration of surgery. RESULTS: Most smokers continued to smoke up until the day of surgery. Smokers had a higher rate of respiratory complications (32.8% vs. 25.9%; adjusted odds ratio, 1.71; 95% confidence interval, 1.03-2.84; = 0.038) and wound infection (3.6% vs. 0.6%; odds ratio, 16.3; 95% confidence interval, 1.58-175; = 0.019). Odds ratios comparing current plus ex-smokers with nonsmokers were of similar magnitude for most of these complications. CONCLUSIONS: Smoking was associated with an increased risk of respiratory complications and postoperative wound infection in ambulatory surgery patients. These findings warrant increased efforts at promoting smoking avoidance and cessation.     

Coronary artery spasm during neurosurgical anesthesia

We experienced a case of coronary artery spasm during neurosurgical anesthesia. A 69-year-old man was scheduled for craniotomy for cerebello-pontine angle meningioma. He had a history of cigarette smoking, but no history or evidence of ischemic heart disease. After the dura mater was opened, marked ST elevation on the ECG monitor followed by ventricular fibrillation was noticed. After successful resuscitation, the surgery was cancelled. Because the coronary angiography, immediately after surgery, demonstrated normal coronary arteries, coronary artery spasm was considered to be the cause of the ECG change. Possible triggering factor in this case was vagal stimulation due to surgical manipulation. Careful anesthetic management is required to prevent intraoperative coronary artery spasm even in patients without a history of ischemic heart disease during neurosurgery.     

Relationship of respiratory symptoms with smoking status and pulmonary function in chronic spinal cord injury

OBJECTIVE: The relationship of respiratory symptoms to pulmonary function parameters and smoking status was assessed in subjects with chronic (>1 year) spinal cord injury (SCI). METHODS AND PARTICIPANTS: As part of their annual physical examination, subjects were queried regarding respiratory symptoms and underwent pulmonary function studies. The 180 patients who successfully completed pulmonary function testing were evaluated, including 79 subjects with tetraplegia (56 nonsmokers and 23 smokers) and 101 subjects with paraplegia (78 nonsmokers and 23 smokers). FINDINGS: Logistic-regression analysis revealed the following independent predictors of breathlessness: level of injury (tetraplegia, paraplegia, odds ratio = 3.5, P < 0.0015), cough combined with phlegm and/or wheeze (CPWZ, odds ratio = 3.1, P < 0.015), total lung capacity percentage predicted (TLC <60%, odds ratio = 3.9, P < 0.02), and expiratory reserve volume (ERV < 0.6 L, odds ratio = 2.5, P < 0.05). Independent predictors of CPWZ were current smoking (odds ratio = 3.3, P < 0.004), breathlessness (odds ratio = 2.9, P < 0.03), and forced expiratory volume in 1 second (FEV1 <60%, odds ratio = 3.2, P < 0.01). CONCLUSION: Altered respiratory mechanics associated with tetraplegia contribute to breathlessness, restrictive ventilatory impairment (low TLC%), and reduced expiratory muscle strength (low ERV). These factors apparently overshadow adverse effects caused by smoking. Conversely, smoking and reduction of airflow (low FEV1%) were predictive of CPWZ, symptoms commonly associated with cigarette use.     

Legg-Calvé-Perthes disease and passive smoking

We carried out a case-control study with 90 patients with Legg-Calvé-Perthes disease (LCPD) and 183 normal children, as controls, selected at random to determine whether the condition of passive smoking is related to the disease. Seventy-one of 90 of the LCPD group (78.9%) were passive smokers. Only 79 of 183 (43.2%) in the control group were passive smokers (p = 0.00000). We did not find any statistical relationship between passive smoking and evolution of the condition (p = 0.42883), Catterall extension (p = 0.60544), final Stulberg result (p = 0.53201), or presence of sequelae (p = 0.53256). We also could not find any statistical difference between ages (p = 0.18). The odds ratio was 5.3203 (95% confidence interval 2.92-9.69). The association between LCPD and passive smoking, after controlling for age and gender, became significant (p = 0.0000). Thus the risk of LCPD in passive smoking children is more than five times higher than in children who are not exposed to smoke. It seems that passive smoking is a factor directly or indirectly associated with LCPD.     

Correlation between myocardial ischemia and changes in arterial resistance during coronary artery bypass surgery.

The arterial resistometer provides continuous on-line monitoring of changes in arterial resistance. Resistance index (Ri), which bears a direct relationship to systemic vascular resistance (SVR), is defined by the equation Ri = P'/(dP'/dt), where dP'/dt is the peak dP/dt of the arterial waveform, and P' is the pressure at dP'/dt. In 42 patients with unstable angina, changes in Ri were studied at six periods during aortocoronary bypass surgery before tracheal intubation, during tracheal intubation, leg elevation, presternotomy, sternotomy, and dissection of the internal mammary artery. Thirty-four episodes of ischemia (0.1 mV ST segment changes) were observed in 26 patients. All ischemic episodes were associated with increased Ri (mean increase, 102 +/- 52%). Elevation of the pulmonary capillary wedge pressure correlated with ischemia during the preintubation, intubation, and sternotomy periods, but not in the remaining periods. Changes in arterial pressure and heart rate were not good predictors of ischemia. The prevalence of ST segment changes increased markedly during all periods of anesthesia with increase in Ri (P less than 0.05). Ninety-one percent of ST segment changes were associated with a 25% increase from the baseline Ri. Raising the cutoff point to a greater than or equal to 75% increase in Ri improved the specificity of Ri in ischemia detection from 61% to 92%. An increase of greater than or equal to 75% in Ri occurred in only 8% of cases without ST segment changes. It was found that an increase in Ri as depicted by the arterial resistometer was the best hemodynamic correlate of myocardial ischemia.     

Cigarette smoking and prostatism: A biphasic association?

Objective. To evaluate the association between cigarette smoking and prostatism in a community-based setting using standardized urinary symptom scores, peak urinary flow rates, and prostatic volume as indicators of disease.Methods. A population-based cohort of 2,115 Caucasian men aged forty to seventy-nine years from Olmsted County, Minnesota, was administered a previously validated questionnaire that elicited information on frequency of urinary symptoms (approximating the American Urological Association's symptom index), and a detailed history on cigarette smoking, including both amount and pack-years of smoking. Peak urinary flow rates were measured by a standard uroflowmeter (Dantec 1000). The prostatic volume was measured for a subsample of 471 men by transrectal ultrasound.Results. Compared to never-smokers, smokers were less likely to have moderate to severe urinary symptoms (age-adjusted odds ratio 0.82; 95% confidence interval [CI] 0.61 to 1.08). This varied by smoking intensity, however; in men who smoked less than 1 pack a day the age-adjusted odds ratio was 0.53 (95% CI 0.33 to 0.83) and among men smoking 1 to 1.4 packs a day, the odds ratio was 0.87 (95% CI 0.56 to 1.36). For men who smoked 1.5 packs or more a day, the odds ratio was elevated at 1.32 (95% CI 0.84 to 2.07). Smokers were less likely to have peak flow rates less than 15 mL/sec compared with never-smokers (age- and voided volume-adjusted odds ratio 0.48; 95% CI 0.35 to 0.66), or prostatic volume greater than 40 mL (odds ratio 0.54; 95% CI 0.19 to 1.55).Conclusions. These data from a community-based sample suggest that light or moderate smokers are less likely to have moderate to severe prostatism, whereas heavy smokers are at least as likely to have moderate to severe prostatism compared with never-smokers.     

Clinical and operative predictors of outcomes of carotid endarterectomy

OBJECTIVE: The net benefit for patients undergoing carotid endarterectomy is critically dependent on the risk of perioperative stroke and death. Information about risk factors can aid appropriate selection of patients and inform efforts to reduce complication rates. This study identifies the clinical, radiographic, surgical, and anesthesia variables that are independent predictors of deaths and stroke following carotid endarterectomy. METHODS: A retrospective cohort study of patients undergoing carotid endarterectomy in 1997 and 1998 by 64 surgeons in 6 hospitals was performed (N = 1972). Detailed information on clinical, radiographic, surgical, anesthesia, and medical management variables and deaths or strokes within 30 days of surgery were abstracted from inpatient and outpatient records. Multivariate logistic regression models identified independent clinical characteristics and operative techniques associated with risk-adjusted rates of combined death and nonfatal stroke as well as all strokes. RESULTS: Death or stroke occurred in 2.28% of patients without carotid symptoms, 2.93% of those with carotid transient ischemic attacks, and 7.11% of those with strokes (P < .0001). Three clinical factors increased the risk-adjusted odds of complications: stroke as the indication for surgery (odds ratio [OR], 2.84; 95% confidence interval [CI] = 1.55-5.20), presence of active coronary artery disease (OR, 3.58; 95% CI = 1.53-8.36), and contralateral carotid stenosis > or =50% (OR, 2.32; 95% CI = 1.33-4.02). Two surgical techniques reduced the risk-adjusted odds of death or stroke: use of local anesthesia (OR, 0.30; 95% CI = 0.16-0.58) and patch closure (OR, 0.43; 95% CI = 0.24-0.76). CONCLUSIONS: Information about these risk factors may help physicians weigh the risks and benefits of carotid endarterectomy in individual patients. Two operative techniques (use of local anesthesia and patch closure) may lower the risk of death or stroke.     

PREDICTORS OF CORONARY DISEASE IN PATIENTS WITH END STAGE RENAL DISEASE

Patients with end stage renal disease have a high prevalence of cardiovascular disease and coronary arteriography is often routinely performed prior to kidney transplantation. However, the value of the conventional risk factors and non-invasive markers of coronary artery disease (CAD) in triaging patients for coronary arteriography has not been fully examined. 116 patients with end stage renal disease were evaluated. Coronary arteriography was performed in all patients either for a suspicion of CAD or as part of a routine pre-transplant evaluation. Lesions causing ≥ 50% luminal diameter stenosis in any of the three major coronary artery systems were considered significant. The mean age was 53.3 ± 9.3 years. Significant CAD was present in 69 patients (60%). Increasing age, family history of premature ischemic heart disease, the presence of angina, abnormal Q waves on the ECG or abnormal ST segment depression and the presence of coronary calcification were significant markers of coronary artery disease. However male gender, diabetes mellitus and obesity did not correlate with coronary disease. Even though hypertension, hypercholesterolemia and smoking were also not useful predictors these could have been modified by the renal failure. In conclusion increasing age, a family history of premature ischemic heart disease and some non-invasive markers were useful predictors of coronary disease.     

Association of cigarette smoking, alcohol consumption and physical activity with lower urinary tract symptoms in older American men: findings from the third National Health And Nutrition Examination Survey

OBJECTIVES: To examine the association of cigarette smoking, alcohol consumption and physical activity with lower urinary tract symptoms (LUTS) in older men. SUBJECTS AND METHODS: The study included 2797 men participating in the Third National Health and Nutrition Examination Survey (NHANES III), who were aged > or = 60 years. During an interview, LUTS, smoking history, alcohol consumption and physical activity were assessed. Cases comprised men with at least three of the symptoms of nocturia, hesitancy, weak stream and incomplete emptying. Men who had had prostate surgery unrelated to cancer were not included as cases. Controls were men with no symptoms or surgery. We adjusted for age and race in logistic regression models and used sampling weights to account for selection probability. RESULTS: Current cigarette smokers had no higher odds of LUTS than 'never' smokers, but former heavy smokers (> or = 50 pack-years) had a higher odds of LUTS than never smokers (odds ratio 2.01; 95% confidence interval 1.04-3.89). Men who drank alcohol daily had a lower chance of LUTS than non-drinkers (0.59; 0.37-0.95; P trend, 0.07). All levels of moderate and vigorous activity were statistically significantly inversely associated with LUTS (P trend, 0.06), whereas men who reported no leisure-time physical activity had a greater odds of LUTS (2.06; 1.26-3.39). CONCLUSIONS: Moderate alcohol consumption and physical activity may be protective against LUTS. Current cigarette smoking was not consistently associated with the condition. The possible association in former smokers warrants further investigation.     

Chronic exposure to nicotine does not prevent neurocognitive decline after cardiac surgery

OBJECTIVE: To establish the association between smoking and cognitive decline in patients undergoing coronary artery bypass graft (CABG) surgery. DESIGN: Retrospective review. SETTING: Referral center for cardiothoracic surgery at a university hospital. PARTICIPANTS: Four hundred seventeen patients undergoing CABG surgery. INTERVENTIONS: Based on preoperative data, patients were divided into 2 groups: smokers (n = 185) and nonsmokers (n = 232). Patients who smoked half a pack of cigarettes per day within the last 2 years were identified as smokers, and patients who did not smoke were included in the nonsmoker group. Patients with less than a seventh grade education; an inability to read; or a history of one of the following medical conditions: prior stroke with residual deficit, psychiatric illness, renal disease (creatinine > 2.0 mg/dL), or active liver disease; or patients who quit smoking prior to surgery were excluded from the study. Both groups received similar anesthetic and surgical management. All patients received a battery of neurocognitive tests both preoperatively and 6 weeks after CABG surgery. Neurocognitive test scores were separated into 4 cognitive domains, with a composite cognitive index (the mean of the four domain scores) determined for each patient at every testing period. MEASUREMENTS AND MAIN RESULTS: The overall rate of cognitive decline at 6 weeks after surgery in smokers was 36.2%, whereas nonsmokers showed a deficit rate of 36.6%. Nonsmokers were significantly older and presented for surgery on average 6 years later than the smokers. Female sex represented a considerably larger proportion of patients in the nonsmoker group. Smokers had a higher prevalence of myocardial infarction. The univariate analysis of cognitive change at 6 weeks adjusted for age, baseline cognitive index, and education years showed no difference between the 2 groups. Sex, history of myocardial infarction, hypertension, stroke, transient ischemic attack, and duration of cardiopulmonary bypass did not contribute to the multivariate logistic regression model and were dropped from the final analysis. Significant multivariate predictors of neurocognitive dysfunction included age, left ventricular ejection fraction, baseline education level, and baseline cognitive index. CONCLUSIONS: This study confirmed previous findings that age, baseline cognitive function, years of education, and impaired left ventricular function are independent predictors of neurocognitive decline at 6 weeks after CABG surgery. Smoking is neither preventive nor causative of cognitive decline after CABG surgery.     

Predictors of long-term mortality and cardiac events in patients with known or suspected coronary artery disease who survive major non-cardiac surgery

The aim of this prospective study was to assess predictors of long-term outcome in patients with documented or suspected coronary artery disease who survive major non-cardiac surgery. The impact of patients' comorbidities, pre-operative heart rate variability and postoperative increase in cardiac troponin I on all-cause mortality and major cardiac events within 2 years was explored using multivariable logistic regression. Six of 173 patients died within the first month after surgery and were excluded from the study. Thirty-four of 167 patients (20%) died 1-24 months after surgery. Independent predictors of all-cause mortality were history of congestive heart failure (odds ratio 6.4 [95%, confidence interval 1.7-24]), pre-operatively depressed heart rate variability (odds ratio 6.4 [95%, confidence interval 1.9-21]), and age > 70 years (odds ratio 4.5 [95%, confidence interval 1.2-16]). In contrast, postoperative elevation of cardiac troponin I did not independently predict all-cause mortality or major cardiac events.     

Smoking and sexual dysfunction in Chinese males: findings from men's health survey

To describe the prevalence of erectile dysfunction (ED) and its association with smoking among the Chinese in Hong Kong, we conducted a cross-sectional study among 819 men (aged 31-60 years) who were randomly selected among the Hong Kong residents and interviewed by trained interviewers. A structured questionnaire was used for data collection. We found that current smokers who smoked 20 cigarettes or more daily had more dissatisfaction, erection difficulty and ED than never smokers. The prevalence of dissatisfaction, difficulty in erection and ED increased significantly (P<0.05) with increasing age. Compared with never-smokers, current smokers of more than 20 cigarettes daily had a greater risk of ED (age-adjusted odds ratio=1.47, 95% confidence interval: 1.00-2.16). Our results support that there are association between ED and smoking among the Chinese and suggest linking ED with smoking in the antismoking campaign and promoting smoking cessation to reduce ED among smokers.     

ST-segment depression and myocardial contractility during Cesarean section under spinal anesthesia

PURPOSE: To evaluate myocardial contractility during ST segment depression in healthy parturients during Cesarean section (CS). METHODS: Forty-seven consecutive term parturients undergoing elective CS under spinal anesthesia were studied. The ST segment was recorded continuously on leads II and V5 using a Holter monitor. Myocardial performance was evaluated by measuring cardiac index (CI), heart rate (HR), pre-ejection period (PEP), ventricular ejection time (VET), systolic time ratio (STR, PEP/VET), and ejection fraction (EF) with an impedance cardiograph. RESULTS: Fourteen patients (30%) developed ST segment depression within 15 min after delivery and the remaining 33 (70%) did not (controls). Seven patients developed a 1 mm change, five patients a 2 mm change and the remaining two a 3 mm change in the ST segment. Compared with pre-anesthesia values, the mean HR increased from 103 +/- 10 to 116 +/- 10 (ISD) bpm (P = 0.001), CI from 4.7 +/- 0.7 to 5.6 +/- 1.7 L.min-1 (P = 0.01), EF from 0.58 +/- 0.08 to 0.66 +/- 0.05 (P = 0.01) and STR decreased from 0.26 +/- 0.06 to 0.2 +/- 0.04 (P = 0.01) during ST segment depression. At this time, CI, HR and EF were greater and STR smaller than values obtained 15 min after delivery in the control subjects. CONCLUSION: ST-segment depression occurring during CS is associated with a hyperkinetic myocardial contractile state.