A heavy smoker is anyone who smokes 20 or more cigarettes per day. Smoking causes several perioperative problems: increased airway reactivity; increased sputum production and retention; bronchospasm; coughing and atelectasis associated with an increased risk of post operative chest infection. Associated diseases include ischaemic heart disease and chronic obstructive pulmonary disease. Up to 15% of the haemoglobin in smokers combines with carbon monoxide to form carboxyhaemoglobin, reducing the oxygen carrying capacity of blood. After 12-24 hours of stopping smoking the effects of carbon monoxide and nicotine are significantly reduced and after 6-8 weeks ciliary and immunological activity are restored. All smokers should be encouraged to abstain prior to theatre.
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