Dear Editor,
The study of Ozturk et al. (1), which was entitled ‘Effect of smoking on reversing neuromuscular block’ and published in Turk J Anaesthesiol Reanim 2016; 44: 206–211, compared the duration of antagonism and efficacy of sugammadex in smokers vs. non-smokers (1). The authors reported that the muscle relaxant was associated with a shorter duration of clinical efficacy and prolonged intubation time and time to reach TOF 0.7–0.8–0.9 values in smokers, albeit statistically non-significant.
In 120 paediatric patients, we evaluated the effects of passive smoking on recovery time and perioperative respiratory complications in the study ‘Effects of passive smoking on respiratory system in elective paediatric cases’, which we recently presented in the TARK 2016 oral contest of clinics (KY08). Children whose parents smoked at home were considered as passive smokers. We found a significantly longer duration of recovery and higher rates of respiratory complications, especially in the postoperative period, in passive smokers than in individuals not exposed to smoking (control group). The recovery time was 20.78±6.14 min and 14.36±4.07 min in the passive smoker group and control group, respectively (p<0.01). While the incidence of respiratory complications during recovery was 31% in the passive smoker group, it was 16% in the control group (p<0.05).
Active or passive smoking impairs ciliary functions in the respiratory tract, leading to increased secretion, which in turn may cause respiratory complications during recovery and prolong the recovery time. Thikkurissy et al. (2) reported a prolonged discharge time from recovery in passive smokers. Hosten Seyidov et al. (3) and Drongowski et al. (4) found increased rates of complication during recovery in passive smokers. In addition, Lakshmipathy et al. (5) showed a 10-fold increase in laryngospasm during anaesthesia in patients exposed to smoking. As reported in the study of Ozturk et al. (1), smoking affects the efficacy of and recovery time from muscle relaxants and even passive smoking may increase the recovery time and respiratory complications. Therefore, considering the possibility of negative influences of either active or passive smoking on anaesthetic procedures, the findings of the study about recovery times from muscle relaxants need to be regarded as clinically relevant, keeping in mind that smoking exposure may be associated with an increase in complication rates and prolonged or troublesome recovery, especially in children.
References
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