Efectividad del programa de suspensión perioperatoria de fumar: estudio clínico randomizado
The effectiveness of a perioperative smoking cessation program: a randomized clinical trial.
Lee SM, Landry J, Jones PM, Buhrmann O, Morley-Forster P.
FRCPC, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Smoking Cessation Study Linda Szabo University Hospital-B3-218, 339 Windermere Rd., London, Ontario, Canada N6A 5A5. suze.lee@utoronto.c.
Anesth Analg. 2013 Sep;117(3):605-13. doi: 10.1213/ANE.0b013e318298a6b0. Epub 2013 Jul 18.
Abstract
BACKGROUND: Cigarette smoking by surgical patients is associated with increased complications, particularly perioperative respiratory problems and poor wound healing. In this study, we sought to determine whether a pragmatic perioperative smoking cessation intervention designed for a busy preadmission clinic would be successful in reducing smoking rates and intraoperative and immediate postoperative complications. METHODS: This randomized controlled trial was conducted at a university-affiliated hospital in London, Ontario, Canada. Patients seen in the preadmission clinic at least 3 weeks preoperatively were randomized to either the control group (84 patients) or the intervention group (84 patients). The control group received no specific smoking cessation intervention. The intervention group received (1) brief counseling by the preadmission nurse, (2) brochures on smoking cessation, (3) referral to the Canadian Cancer Society's Smokers' Helpline, and (4) a free 6-week supply of transdermal nicotine replacement therapy. All outcome assessors and caregivers on the operative day were blinded to group assignment. The primary outcome was the rate of smoking cessation as confirmed by exhaled carbon monoxide breath test. Secondary outcomes included perioperative complications and smoking status at 30 days postoperatively. RESULTS:
Between October 2010 and April 2012, 168 patients were recruited into the tudy. Smoking cessation occurred in 12 patients (14.3%) in the intervention group as compared with 3 patients (3.6%) in the control group (relative risk 4.0; 95% confidence interval [CI], 1.2-13.7; P = 0.03). The overall rate of combined intraoperative and immediate postoperative complications was not significantly different between intervention and control groups (13.1% and 16.7%, respectively; relative risk 0.79; 95% CI, 0.38-1.63; P = 0.67). At follow-up 30 days postoperatively, smoking cessation was reported in 22 patients (28.6%) in the intervention group compared with 8 patients (11%) in controls (relative risk 2.6; 95% CI, 1.2-5.5; P = 0.008). CONCLUSIONS: One of the objections to widespread use of smoking cessation interventions in the preadmission clinic is that it is too labor-intensive. The results of this study show that a smoking cessation intervention, designed to minimize additional use of physician or nursing time, results in decreased smoking rates on the day of surgery and promotes abstinence 30 days postoperatively.
http://www.anesthesia-analgesia.org/content/117/3/605.full.pdf
Intervenciones del tabaco y anestesia
Tobacco interventions and anaesthesia- a review.
Saha U.
Professor, Dept of Anaesthesiology, Lady Hardinge Medical College, Smt. Sucheta Kriplani & Kalawati Saran Childrens Hospital, New Delhi, 110001.
Indian J Anaesth. 2009 Oct;53(5):618-27.
Abstract
SUMMARY:
Tobacco use is the leading preventable agent of death in the world. It is manufactured on a large scale in India and has a huge international market also. Death toll from tobacco use is on the rise. Use of tobacco is also increasing esp. in developing countries, in teenagers & in women, despite government, WHO and intervention by other statutory bodies. Prolonged use of tobacco or its products, as smoke or chew, endows significant risk of developing various diseases. With advances in surgical and anaethesia techniques & prolonged life expectancy, anaesthetist will be faced with management of these patients. Tobacco consumption affects every major organ system of the body; esp. lung, heart and blood vessels. Perioperative smoking cessation can significantly reduce the risk of postoperative complications & duration of hospital stay. Anaesthetist can play an important role in motivating these patients to quit smoking preoperatively by providing brief counselling and nicotine replacement therapy in reluctant quitters. More of concern is the effect of passive smoking (second & third hand smoke) on non smokers. This is a review of tobacco & its products, their health consequences, diseases caused, anaesthetic considerations & their role in helping these patients quit smoking Preventing nicotine addiction and improving smoking cessation strategies should be the priority and despite these being only partially successful, strong measures at all levels should be continued & enforced. KEYWORDS: Anaesthetic considerations, COPD, Carcinogenesis, Diseases, Health effects, Interventions, Lung cancer, Passive smoking, Preoperative advice, Second hand smoke, Smoking, Tobacco
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900094/
Efecto de la exposición pasiva al humo del tabaco sobre la anestesia dental general en niños
Effect of passive smoke exposure on general anesthesia for pediatric dental patients.
Thikkurissy S, Crawford B, Groner J, Stewart R, Smiley MK.
The Ohio State University College of Dentistry, Columbus, OH, USA. thikkurissy.1@osu.edu
Anesth Prog. 2012 Winter;59(4):143-6. doi: 10.2344/0003-3006-59.4.143
Abstract
The purpose of this study was to test the null hypothesis that children with environmental tobacco smoke (ETS) exposure (also known as passive smoke exposure) do not demonstrate an increased likelihood of adverse respiratory events during or while recovering from general anesthesia administered for treatment of early childhood caries. Parents of children (ages 19 months-12 years) preparing to receive general anesthesia for the purpose of dental restorative procedures were interviewed regarding the child's risk for ETS. Children were observed during and after the procedure by a standardized dentist anesthesiologist and postanesthesia care unit nurse who independently recorded severity of 6 types of adverse respiratory events-coughing, laryngospasm, bronchospasm, breath holding, hypersecretion, and airway obstruction. Data from 99 children were analyzed. The children for whom ETS was reported were significantly older than their ETS-free counterparts . If the primary caregiver smoked, there was a significantly higher incidence of smoking by other members of the family (P < .0001) as well as smoking in the house (P < .0005). There were no significant differences between the adverse respiratory outcomes of the ETS (+) and ETS (-) groups. The ETS (+) children did have significantly longer recovery times (P < .0001) despite not having significantly more dental caries (P = .38) or longer procedure times. ETS is a poor indicator of post-general anesthesia respiratory morbidity in children being treated for early childhood caries.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522491/pdf/i0003-3006-59-4-143.pdf
Atentamente
Dr. Francisco Martínez-Pelayo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
The effectiveness of a perioperative smoking cessation program: a randomized clinical trial.
Lee SM, Landry J, Jones PM, Buhrmann O, Morley-Forster P.
FRCPC, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Smoking Cessation Study Linda Szabo University Hospital-B3-218, 339 Windermere Rd., London, Ontario, Canada N6A 5A5. suze.lee@utoronto.c.
Anesth Analg. 2013 Sep;117(3):605-13. doi: 10.1213/ANE.0b013e318298a6b0. Epub 2013 Jul 18.
Abstract
BACKGROUND: Cigarette smoking by surgical patients is associated with increased complications, particularly perioperative respiratory problems and poor wound healing. In this study, we sought to determine whether a pragmatic perioperative smoking cessation intervention designed for a busy preadmission clinic would be successful in reducing smoking rates and intraoperative and immediate postoperative complications. METHODS: This randomized controlled trial was conducted at a university-affiliated hospital in London, Ontario, Canada. Patients seen in the preadmission clinic at least 3 weeks preoperatively were randomized to either the control group (84 patients) or the intervention group (84 patients). The control group received no specific smoking cessation intervention. The intervention group received (1) brief counseling by the preadmission nurse, (2) brochures on smoking cessation, (3) referral to the Canadian Cancer Society's Smokers' Helpline, and (4) a free 6-week supply of transdermal nicotine replacement therapy. All outcome assessors and caregivers on the operative day were blinded to group assignment. The primary outcome was the rate of smoking cessation as confirmed by exhaled carbon monoxide breath test. Secondary outcomes included perioperative complications and smoking status at 30 days postoperatively. RESULTS:
Between October 2010 and April 2012, 168 patients were recruited into the tudy. Smoking cessation occurred in 12 patients (14.3%) in the intervention group as compared with 3 patients (3.6%) in the control group (relative risk 4.0; 95% confidence interval [CI], 1.2-13.7; P = 0.03). The overall rate of combined intraoperative and immediate postoperative complications was not significantly different between intervention and control groups (13.1% and 16.7%, respectively; relative risk 0.79; 95% CI, 0.38-1.63; P = 0.67). At follow-up 30 days postoperatively, smoking cessation was reported in 22 patients (28.6%) in the intervention group compared with 8 patients (11%) in controls (relative risk 2.6; 95% CI, 1.2-5.5; P = 0.008). CONCLUSIONS: One of the objections to widespread use of smoking cessation interventions in the preadmission clinic is that it is too labor-intensive. The results of this study show that a smoking cessation intervention, designed to minimize additional use of physician or nursing time, results in decreased smoking rates on the day of surgery and promotes abstinence 30 days postoperatively.
http://www.anesthesia-analgesia.org/content/117/3/605.full.pdf
Intervenciones del tabaco y anestesia
Tobacco interventions and anaesthesia- a review.
Saha U.
Professor, Dept of Anaesthesiology, Lady Hardinge Medical College, Smt. Sucheta Kriplani & Kalawati Saran Childrens Hospital, New Delhi, 110001.
Indian J Anaesth. 2009 Oct;53(5):618-27.
Abstract
SUMMARY:
Tobacco use is the leading preventable agent of death in the world. It is manufactured on a large scale in India and has a huge international market also. Death toll from tobacco use is on the rise. Use of tobacco is also increasing esp. in developing countries, in teenagers & in women, despite government, WHO and intervention by other statutory bodies. Prolonged use of tobacco or its products, as smoke or chew, endows significant risk of developing various diseases. With advances in surgical and anaethesia techniques & prolonged life expectancy, anaesthetist will be faced with management of these patients. Tobacco consumption affects every major organ system of the body; esp. lung, heart and blood vessels. Perioperative smoking cessation can significantly reduce the risk of postoperative complications & duration of hospital stay. Anaesthetist can play an important role in motivating these patients to quit smoking preoperatively by providing brief counselling and nicotine replacement therapy in reluctant quitters. More of concern is the effect of passive smoking (second & third hand smoke) on non smokers. This is a review of tobacco & its products, their health consequences, diseases caused, anaesthetic considerations & their role in helping these patients quit smoking Preventing nicotine addiction and improving smoking cessation strategies should be the priority and despite these being only partially successful, strong measures at all levels should be continued & enforced. KEYWORDS: Anaesthetic considerations, COPD, Carcinogenesis, Diseases, Health effects, Interventions, Lung cancer, Passive smoking, Preoperative advice, Second hand smoke, Smoking, Tobacco
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900094/
Efecto de la exposición pasiva al humo del tabaco sobre la anestesia dental general en niños
Effect of passive smoke exposure on general anesthesia for pediatric dental patients.
Thikkurissy S, Crawford B, Groner J, Stewart R, Smiley MK.
The Ohio State University College of Dentistry, Columbus, OH, USA. thikkurissy.1@osu.edu
Anesth Prog. 2012 Winter;59(4):143-6. doi: 10.2344/0003-3006-59.4.143
Abstract
The purpose of this study was to test the null hypothesis that children with environmental tobacco smoke (ETS) exposure (also known as passive smoke exposure) do not demonstrate an increased likelihood of adverse respiratory events during or while recovering from general anesthesia administered for treatment of early childhood caries. Parents of children (ages 19 months-12 years) preparing to receive general anesthesia for the purpose of dental restorative procedures were interviewed regarding the child's risk for ETS. Children were observed during and after the procedure by a standardized dentist anesthesiologist and postanesthesia care unit nurse who independently recorded severity of 6 types of adverse respiratory events-coughing, laryngospasm, bronchospasm, breath holding, hypersecretion, and airway obstruction. Data from 99 children were analyzed. The children for whom ETS was reported were significantly older than their ETS-free counterparts . If the primary caregiver smoked, there was a significantly higher incidence of smoking by other members of the family (P < .0001) as well as smoking in the house (P < .0005). There were no significant differences between the adverse respiratory outcomes of the ETS (+) and ETS (-) groups. The ETS (+) children did have significantly longer recovery times (P < .0001) despite not having significantly more dental caries (P = .38) or longer procedure times. ETS is a poor indicator of post-general anesthesia respiratory morbidity in children being treated for early childhood caries.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522491/pdf/i0003-3006-59-4-143.pdf
Atentamente
Dr. Francisco Martínez-Pelayo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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