Journal of Addiction Medicine and Therapeutic Science
Role of an Anesthesiologist in Smoking Patients Undergoing Endoscopic Procedures
Department of Anesthesiology, Faculty of Medicine Siri raj Hospital, Mahidol University, Bangkok, Thailand
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Amornyotin S (2017) Role of an Anesthesiologist in Smoking Patients Undergoing Endoscopic Procedures. J Addict Med Ther Sci. 2017; 3(1): 30-31. Available from: 10.17352/2455-3484.000023
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© 2017 Amornyotin S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Smoking is associated with a range of diseases, causing a high level of morbidity and mortality and is a risk factor for several perioperative complications [1]. The consequences of smoking on surgical outcomes are associated with the toxic effects of recent smoke inhalation and the cumulative chronic effects of tobacco exposure. Many smoking patients require some medical interventions and care by anesthesiologists. Consequently, smoking is of direct concerns to periprocedural management [1,2]. The preoperative clinic is an ideal setting to initiate interventions for smoking cessation. Importantly, preprocedural interventions for tobacco use are effective to decrease postprocedural complications and increase the likelihood of long-term abstinence. If intensive interventions are impractical, brief interventions should be implemented in preprocedural clinics as a routine practice [3]. Anesthesiologists
should ask their patients about smoking, advice the smokers to quit, and connect them directly to counseling resources. However, most anesthesiologists ask their patients about smoking but frequently do not advise smokers to quit [4].
Smoking is associated with a range of diseases, causing a high level of morbidity and mortality and is a risk factor for several perioperative complications [1]. The consequences of smoking on surgical outcomes are associated with the toxic effects of recent smoke inhalation and the cumulative chronic effects of tobacco exposure. Many smoking patients require some medical interventions and care by anesthesiologists. Consequently, smoking is of direct concerns to periprocedural management [1,2]. The preoperative clinic is an ideal setting to initiate interventions for smoking cessation. Importantly, preprocedural interventions for tobacco use are effective to decrease postprocedural complications and increase the likelihood of long-term abstinence. If intensive interventions are impractical, brief interventions should be implemented in preprocedural clinics as a routine practice [3]. Anesthesiologists should ask their patients about smoking, advice the smokers to quit, and connect them directly to counseling resources. However, most anesthesiologists ask their patients about smoking but frequently do not advise smokers to quit [4].
For endoscopic patients, smoking has been shown to be an important risk factor for colorectal neoplasia in several studies [5-7]. A previous study evaluated the relationship between smoking and flat colorectal neoplasia. Six hundred asymptomatic patients presenting for first-time colonoscopic screening were studied. The study confirmed that smoking might be significantly associated with flat adenomas, especially those that might be the most clinically relevant [8]. Moreover, cigarette smoking was associated with an increased risk of Barrett’s esophagus, a premalignant condition to esophageal adenocarcinoma. Being an ever-smoker was associated with an increased risk of Barrett’s esophagus. A greater number of pack-years smoked were related with a higher risk of Barrett’s esophagus [9].
Almost all anesthesiologists reported asking their patients whether they smoked cigarettes. However, the frequency of counseling is less in their practices when compared with primary care physicians [10]. Generally, anesthesiologists have the opportunity to support the patients’ quit attempt, the intervention should contain of helping the patient with a quit plan, providing practical counseling and assisting the patient obtain extra-treatment. The most logical time for anesthesiologists to conduct the intervention is during a visit to the preprocedural clinic [11,12]. Our previous study demonstrated that brief advice provided during the pre-assessment preparation of ambulatory endoscopic patients by busy anesthetic personnel to quit smoking was an effective intervention in the setting of a developing country. The result of the study was also confirmed that anesthetic personnel could help the smoker patients to quit smoking [13]. The development of pre-anesthetic preparation for medical procedures in the hospitals should be implemented.
Smoker patients are more likely to accept brief advice given by anesthetic personnel than their physicians. In addition, smoker patients are also afraid of higher postanesthetic complications if they do not agree with the preprocedural preparation. Interestingly, the well-educated smokers who know that smoking is a risk factor of gastrointestinal diseases, trend to quit smoking by themselves because of their health problems. Brief advice for smoking cessation intervention consists of ask about tobacco use, advice to quit, assess willingness to make attempt to quit, assist with treatments, and arrange follow up [14]. Several factors associated with successful smoking cessation are age, sex, social status, housing condition, spouse/cohabitant’s smoking behavior, daily consumption of tobacco, and willingness to make repeated pharmacotherapy-assisted quit attempts [15]. However, the lack of time and knowledge about smoking cessation interventions as well as inadequate training and funding to offer counselling are still barriers for anesthesiologists [16].
- Gronkjaer M, Eliasen M, Skov-Ettrup LS, Tolstrup JS, Christiansen AH, et al. (2014) Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg 259: 52-71. Link: https://goo.gl/4iUs17
- Hawn MT, Houston TK, Campagna EJ, Graham LA, Singh J, et al. (2011) The attributable risk of smoking on surgical complications. Ann Surg 254: 914-920. Link: https://goo.gl/2D6s3L
- Yousefzadeh A, Chung F, Wong DT, Warner DO, Wong J (2016) Smoking cessation: the role of the anesthesiologist. Anesth Analg 122: 1311-1320. Link: https://goo.gl/b97Yf4
- Shi Y, Yu C, Luo A, Huang Y, Warner DO (2010) Perioperative tobacco interventions by Chinese anesthesiologists: practices and attitudes. Anesthesiology 112: 338-346. Link: https://goo.gl/q6Zeph
- Botteri E, Iodice S, Raimondi S, Maisonneuve P, Lowenfels AB (2008) Cigarette smoking and adenomatous polyps: a meta-analysis. Gastroenterology 134: 388-395. Link: https://goo.gl/aXMR5T
- Gandini S, Botteri E, Iodice S, Boniol M, Lowenfels AB, et al. (2008) Tobacco smoking and cancer: a meta-analysis. Int J Cancer 1: 155-164. Link: https://goo.gl/Kiqyc9
- Amornyotin S, Prakanrattana U, Tritrakarn T, Kachintorn U, Muangman S, et al. (2008) Patient characteristics and behaviors of smokers and nonsmokers who undergoing gastrointestinal endoscopy in Siriraj Hospital. Siriraj Med Bull 1: 71-80. (In Thai) Link:
- Anderson JC, Stein B, Kahi CJ, Rajapakse R, Walker G, et al. (2010) Association of smoking and flat adenomas: results from an asymptomatic population screened with a high definition colonoscope. Gastrointest Endosc 71: 1234-1240. Link: https://goo.gl/DjC4JB
- Andrici J, Cox MR, Eslick GD (2013) Cigarette smoking and the risk of Barrett’s esophagus: a systematic review and meta-analysis. J Gastroenterol Hepatol 28: 1258-1273. Link: https://goo.gl/yZJCZW
- Wong J, Chung F (2015) Peri-operative cessation of smoking: time for anesthetists to act. Anaesthesia 70: 893-906. Link: https://goo.gl/ZKh1fL
- Warner DO, The American Society of Anesthesiologists Smoking Cessation Initiative Task Force (2009) Feasibility of tobacco interventions in anesthesiology practices. Anesthesiology 110: 1223-1228. Link: https://goo.gl/qRFp4b
- Quraishi SA, Orkin FK, Roizen MF (2006) The anesthesia preoperative assessment: an opportunity for smoking cessation intervention. J. Clin Anesth 18: 635-640. Link: https://goo.gl/xdaXng
- Amornyotin S, Prakanrattana U, Chalayonnawin W, Kongphlay S (2012) Brief advice offered by anesthetic personnel to encourage smoking cessation in ambulatory gastrointestinal endoscopic patients in a developing country. Int J Life Sci Med Res 2: 37-42. Link: https://goo.gl/vT4CTb
- Fiore M, Jaen CR, Baker TB, Bailey WC, Bennett G, et al. (2008) A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med 35: 158-176. Link: https://goo.gl/mVFD3h
- Fernandez E, Schiaffino A, Borrell C, Benach J, Ariza C, et al. (2006) Social class, education, and smoking cessation: long-term follow-up of patients treated at a smoking cessation unit. Nicotine Tob Res 8: 29-36. Link: https://goo.gl/7pCC9F
- Ratner PA, Johnson JL, Richardson CG, Bottorff JL, Moffat B, et al. (2004) Efficacy of a smoking-cessation intervention for elective-surgical patients. Res Nurs Health 27: 148-161. Link: https://goo.gl/Mhf5fi
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