Changes in arterial oxygen saturation in cigarette smokers following general anaesthesia

The effect of cigarette smoking on postoperative arterial oxygen saturation was evaluated in 45 adult patients using pulse oximetry. Patients were divided into a smoking group (n = 20) and a non-smoking group (n = 25) based on current smoking habits up until the time of surgery. The two groups were similar with respect to sex, ASA physical status, surgical procedure, duration of anaesthesia, narcotic and anaesthetic use and recovery characteristics. The non-smoking group was, however, significantly (P < 0.05) older than the smoking group. Postoperative oxygen saturation (SaO₂) decreased (P < 0.001) during transport of both groups of patients from the Operating Room to the Recovery Room; a decrease which was significantly greater in the smoking group. The severity of hypoxaemia was also significantly greater in the smoking group than in the non-smoking group. This study suggests that cigarette smoking contributes to postoperative arterial oxygen desaturation following general anaesthesia and that supplemental oxygen should be administered to these patients during postoperative transport.     

Lung structure and function in cigarette smokers.

BACKGROUND--Cigarette smoking produces an inflammatory response in the airways of everyone but only 15-20% of smokers develop airways obstruction. The present study concerns the relative importance of peripheral airways inflammation and the emphysematous destruction of the parenchymal support of the airways in the pathogenesis of this obstruction. METHODS--A total of 407 patients with a diagnosis of lung tumour performed pulmonary function tests a day or two before a lung or lobar resection. The specimens were fixed in inflation and analysed at the gross and microscopic level to determine the extent and severity of the emphysematous process, the number of alveoli supporting the outer walls of the airways, and the average distance between alveolar walls. The severity of the inflammatory process in the respiratory and nonrespiratory bronchioles was also assessed using a previously established grading system. RESULTS--The lung function test showed that a decline in FEV1 was associated with an increase in residual volume and a decrease in the diffusing capacity for carbon monoxide and a reduction in the lung maximum elastic recoil pressure. The prevalence of grossly visible emphysema increased as FEV1 declined, but the extent and severity of these lesions and the number of alveoli supporting the outer walls of the peripheral airways was similar at all levels of FEV1. The system used to grade inflammatory response in the peripheral airways failed to identify a specific defect responsible for the physiological abnormalities. CONCLUSION--The reduction in FEV1 associated with chronic cigarette smoking can be partially explained by loss of lung elastic recoil pressure which reduces the force driving air out of the lung. This loss of elastic recoil pressure is attributed to microscopic enlargement of the air spaces rather than to grossly visible emphysema. The exact nature of the lesions responsible for the peripheral airways obstruction remains to be identified.     

Carboxyhaemoglobin levels and inhaling habits in cigarette smokers.

In 520 men who currently smoked only cigarettes, carboxyhaemoglobin (COHb) levels were measured as a method of estimating the extent to which cigarette smoke was inhaled and the results were compared with the smokers' own assessment of their inhaling habits. The mean COHb level after standardising for the number of cigarettes smoked before the blood test on the day of the test was 4.0% in self-described non-inhalers. This was much higher than the mean level of 0.7% in 1891 similar non-smokers, but not very different from the standardised mean levels of 5.2%, 5.3%, and 5.6% in men who said they inhaled slightly, moderately, or deeply, respectively. The increasing trend in the COHb levels of men in the four self-described inhaling categories (nil to deep) was small but statistically highly significant. The data from this study may help to explain some of the anomalous epidemiological results regarding the relationship between self-described inhaling habits and the development of diseases associated with smoking, such as coronary heart disease and lung cancer.     

Functional small airways defence in symptomless cigarette smokers.

Smoking induced changes in the secretory cells of bronchiolar epithelium by facilitating secretion of cross linked glycoprotein mucus may influence the efficiency of mucus-cilia coupling. The functional impact on mucociliary transport in small (peripheral) airways has been studied by comparing data on aerosol deposition and clearance from symptomless cigarette smokers (30 tests, 18 subjects) with data from age matched non-smokers (30 tests, 19 subjects). Gamma camera images, assessed in terms of a penetration index comparing peripheral with inner zone deposition, indicated closely similar initial deposition in the two groups. Alveolar deposition, however, assessed in terms of particle retention at 24 hours, was significantly (p less than 0.01) less in the smokers. Given the similarity of initial deposition, this implies that an increased proportion of small conducting airways are protected by mucociliary defence in the smokers' lungs. Clearance from conducting airways of the peripheral zone in tests with relatively high peripheral deposition (14 tests on smokers, and 12 on non-smokers) nevertheless proceeded at the same rate in smokers as in non-smokers.     

Cholesterol in the lungs of heavy cigarette smokers.

Electron microscopy of "normal" lung tissue from four heavy cigarette smokers showed acicular crystal clefts thought to represent cholesterol in the cytoplasm of virtually every type II pneumocyte. Similar but less pronounced changes were found in two cases of obstructive pneumonia distal to bronchial tumours, a condition characterised by excess cholesterol. Cholesterol pneumonitis is particularly prevalent in smokers, and the changes in our smokers' lungs possible represent an early stage in a process that if progressive would lead to this disease. The cholesterol may represent a degenerative change in type II pneumocytes or a byproduct of increased surfactant synthesis stimulated by cigarette smoke.     

Nocturnal penile tumescence in cigarette smokers with erectile dysfunction.

We examined the relationship between cigarette smoking and erectile physiology in 314 men with erectile dysfunction. All of the men studied were currently cigarette smokers. Evaluations included interviews, physical examinations, and polysomnographic assessment of sleep-related erections. Penile rigidity during nocturnal erection inversely correlated with the number of cigarettes smoked per day. Smoking was also associated with indices of impairment on autonomic function tests and some measures of penile blood pressure. The group of men who smoked the most (more than 40 cigarettes per day) had the fewest minutes of nocturnal tumescence and detumesced fastest. These data are discussed with respect to the results of studies performed in dogs that demonstrated smoking-related reduction in arterial flow and venous restriction. Our findings suggest that smoking may further compromise penile physiology in men experiencing difficulty in maintaining erections long enough for satisfactory intercourse.     

Urinary nicotine concentrations in cigarette and pipe smokers

Urinary concentrations of nicotine were studied in men who did not smoke (27) and in men who smoked cigarettes only (145) or pipes only (48). The median urinary nicotine concentrations were less than 50 ng/ml (the detection limit of the assay for urine tests) in the non-smokers, 1393 ng/ml in the cigarette smokers, and 1048 ng/ml in the pipe smokers. These values were standardised for urinary pH and creatinine concentration to allow for the fact that nicotine excretion is influenced by the acidity of the urine and by urinary flow rate. The high urinary nicotine concentrations in the pipe and cigarette smokers indicated that both types of smoker have relatively high systemic nicotine concentrations. This observation, together with the fact that large prospective studies have shown that pipe smokers have no material excess risk of coronary heart disease whereas cigarette smokers do, provides evidence that nicotine is unlikely to be the major cause of the excess deaths from coronary heart disease in cigarette smokers. This conclusion is consistent with earlier observations based on serum cotinine concentrations in smokers and non-smokers.     

Peripheral arterial embolectomy in the aged.

A series of 65 geriatric patients, operated upon for 76 peripheral arterial embolic events, is presented. The underlying condition was rheumatic heart disease in 8 and arteriosclerotic in 57. No patient was denied surgery unless widespread irreversible ischemia of the limb was present. Limb salvage was accomplished in 35 patients (54%). It was influenced by age, the underlying disease and time elapsed until resumption of circulation to the limb. The mortality rate experienced in this series was very high. 31 patients (48%) died postoperatively, mainly from cardiorespiratory failure. Death was related to the severity of the patients condition before surgery. 29 out of the 34 surviving patients were discharged with a viable limb. The high death rate observed is discussed.     

Lower extremity arterial disease in young adults. A systematic approach to early diagnosis.

General and vascular surgeons are consulted occasionally to evaluate young adults with ischemia of the lower extremity. Between 1975 and 1985, 51 adults under 40 years of age who had arterial occlusive disease of the lower limb were managed. Although premature atherosclerosis was the most common problem (50%), claudication or limb-threatening ischemia also resulted from other sources (thromboembolism, popliteal artery entrapment, Buerger's disease, collagen vascular disease, and Takayasu's arteritis). Identifying the exact cause was sometimes difficult. The authors were impressed with the number of young adults who had delay in diagnosis and treatment (30 patients, 59%) before referral for a surgical opinion. In this paper, the attempt has been made to uncover the reasons for delayed diagnosis and to suggest a systematic approach that should lead to early recognition of lower extremity ischemia in this age group.     

Spinal abnormalities in young fast bowlers.

The action of fast bowling in the game of cricket is known to cause injuries to the lumbar spine. We studied a group of 16- to 18-year-old fast bowlers, selected for special training in Western Australia. All 24 had MR scans of the spine, 22 had radiographs and CT scans; in 20 the bowling technique was analysed biomechanically. There was a high incidence of back pain and this was always associated with a radiological abnormality. Pars interarticularis defects were diagnosed in 54% and intervertebral disc degeneration in 63%. Bowling actions which involved counter-rotation were associated with a higher incidence of both injuries.     

Peripheral arterial occlusion in acute promyelocytic leukemia.

A 16-year-old Caucasian teenager developed fatigue, abdominal pain, pneumonia, and subsequently acute vascular occlusion of the left superficial femoral artery. Vascular assessment and heparin therapy lead to bone marrow aspiration and a diagnosis of acute promyelocytic leukemia. Treatment with chemotherapy prevented loss of limb and avoided further vascular surgery. Young patients with acute vascular occlusion require an in-depth assessment including attention to hematological disorders. Clots obtained on thromboembolectomy should be sent for pathological assessment and not discarded, especially in an unusual-age patient for arterial embolus.     

血管回声跟踪技术定量评价国人健康中青年男性吸烟者颈动脉弹性

目的探讨血管回声跟踪(ET)技术定量评价国人健康中青年男性吸烟者颈动脉血管壁弹性变化的临床应用价值。方法收集92名中青年男性吸烟者,将其按照年龄分为A组30~39岁(n=20)、B组39~49岁(n=40)、C组49~59岁(n=32)。采用ET技术定量评价颈总动脉的僵硬度(β)、弹性模量(Ep)、顺应性(AC)、膨大指数(AI)、脉搏波传导速度(PwVβ)及内-中膜厚度(IMT),同时与国人男性正常标准值对照,并进行统计学分析。结果颈总动脉的β、Ep、PWVβ和AI、IMT值均随年龄增大而呈上升趋势,AC值随年龄增大而呈下降趋势,组间比较差异均有统计学意义(P均0.05)。年龄与AI值呈正相关(r=0.492,P=0.027),尼古丁依赖与β、IMT值呈负相关(r=-0.383、-0.446,P=0.033、0.012)。结论 ET技术可较好地早期检测颈动脉血管壁弹性变化,其中颈动脉β、Ep反映中青年男性吸烟者动脉弹性变化更为敏感,尼古丁依赖可能是中年男性吸烟者颈动脉弹性的危险因素。     

Cigarette smoking habits and urine characteristics: urinalysis abnormalities are more common is smokers, but the reasons are unclear

Voided urines of 53,000 white and 9,3000 black cigarette smokers and nonsmokers were studied. Proteinuria was found to be commoner in smokers of both races and sexes. Heavy smokers showed proteinuria more frequently than light smokers. Of eight possible explanatory variables, one, alcohol consumption history, showed some interrelationship in that the smoking status-proteinuria association disappeared among heavy drinkers. Stopping smoking was not associated with a relative decline in proteinuria prevalence. Proteinuria associated with smoking did not appear to be indicative of more serious renal disease. There was a smoker-nonsmoker difference in urine glucose response to oral glucose challenge, apparently explained by higher average 1-hour serum glucose values for smokers, of unknown mechanism but partially explained by differences in alcohol usage. Hematuria, bacteriuria, and high urine acidity tended to be more prevalent in smokers, though these relationships were not consistently significant.     

Peripheral arterial emboli and factors in their recurrence rate.

One hundred six patients who underwent a total of 141 operations, on 156 limbs for peripheral arterial emboli from 1964 to 1979 were studied. The average age of the patients was 68.5 years. The source of the emboli in 76.4% of the patients was arteriosclerotic heart disease and atrial fibrillation. The presenting clinical symptoms and signs were the most accurate determinate of limb salvage. Our overall limb salvage was 86.5% and in the survivor population 93.9%. The overall hospital mortality was 21.7%. There were much higher morbidity and mortality rates associated with each subsequent embolic event. Particular attention was paid to factors related to recurrent emboli. The use of antigoagulants in the post embolectomy period does not have a statistically significant effect of preventing recurrent emboli.     

Sperm DNA and RNA abnormalities in fertile and oligoasthenoteratozoospermic smokers

This study aimed to assess sperm DNA and RNA abnormalities in fertile and oligoasthenoteratozoospermic (OAT) smokers. In all, 140 subjects were included and classified into fertile nonsmokers, fertile smokers, OAT nonsmokers and OAT smokers. They were subjected to history taking, clinical examination, semen analysis, assessment of sperm DNA and RNA abnormalities. The results showed that an increased percentage of abnormal sperm DNA and RNA was demonstrated in fertile smokers compared with fertile nonsmokers and in OAT smokers compared with OAT nonsmokers. Increased percentage of severe, moderate sperm DNA and RNA damage was demonstrated in fertile heavy smokers compared with fertile light smokers and in OAT heavy smokers compared with OAT light smokers. It is concluded that smoking has a negative impact on sperm DNA and RNA abnormalities that is accentuated in heavy smokers compared with light smokers.     

Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery

BACKGROUND: The forced abstinence from cigarettes accompanying surgery in smoke-free facilities may increase psychological stress by removing a coping mechanism and by nicotine withdrawal. The authors tested the hypothesis that abstinence from cigarette smoking contributes to psychological stress in the perioperative period. METHODS: The authors assessed measures of nicotine withdrawal (Hughes-Hatsukami nicotine withdrawal scale) and perceived stress (including the Perceived Stress Scale) in 141 cigarette smokers scheduled to undergo elective surgery. To separate the effects of stress arising from tobacco abstinence from the effects of other perioperative stressors, such as pain, these measures were also obtained in 150 surgical patients who did not use tobacco. Assessments were performed at intervals beginning at the time of preoperative medical evaluation and ending 30 days postoperatively. RESULTS: Perceived Stress Scale scores were significantly (P < 0.001) higher in smokers throughout the study period. There was little significant interaction between smoking status and time, indicating that changes in Perceived Stress Scale score during the perioperative period did not differ between smokers and nonsmokers. The same result was found if analysis was restricted to data collected before hospital discharge (and thus during assured abstinence). Similar results were found for the nicotine withdrawal scale, suggesting that smokers did not experience more withdrawal symptoms relative to nonsmokers. CONCLUSIONS: Although smokers report increased baseline stress, smoking status does not affect changes in perceived stress over the perioperative period. Nicotine withdrawal symptoms do not seem to be a clinically significant problem in the perioperative period for most smokers.     

Gallbladder disease in the young male.

Eighteen of 2,614 patients undergoing cholecystectomy in two large general hospitals were males between the ages of two and twenty years. The great majority presented with a typical symptoms of cholecystitis. Ten of the eighteen had idiopathic cholelithiasis, with no predisposing factors generally associated with an increased incidence of this disease. This diagnosis must be kept in mind in dealing with patients of this age group.