All patients who smoke should understand that smoking cessation even immediately before surgery has profound, measurable health benefits. Nicotine is a stimulant and has a half-life of only 1 to 2 hours; its adverse effects on systolic blood pressure and heart rate can be seen after only 12 hours of smoking cessation. Carbon monoxide (CO), which diminishes oxygen-carrying capacity, has a half-life of only 4 hours. Diminished levels of nicotine and CO were likely behind the outcome of a study looking at episodes of ST depression in patients who smoked and underwent vascular surgery. This study showed that patients who smoked immediately before surgery had increased episodes of ST segment depression when compared to nonsmokers, prior smokers, and chronic smokers who did not smoke before surgery.
The longer a patient can abstain from smoking before surgery, the greater the perioperative health benefit: Bronchociliary function improves within 2 to 3 days of cessation, and sputum volume decreases to normal levels within about 2 weeks. A study of 120 orthopedic surgery patients randomized to receive an intervention to help them stop smoking 6 to 8 weeks before surgery saw a dramatic decrease in the overall complication rate in the smoking cessation group, mainly from diminished wound infections.
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