Smoking and Anesthesia: What’s at Risk?

| May 20, 2013 | 10 Comments

Are you a smoker who is about to have surgery and anesthesia? Are you worried about the effects of anesthesia in smokers? These answers and more to follow.

The most obvious fact is that smoking cigarettes is not good for you. It has deleterious effects on a variety of organ systems. So when should you quit smoking before your surgery? There is no better time than right now to take care of your health and quit smoking.

The Effects of Smoking on Anesthesia and Surgery

I want to highlight some specific negative consequences of smoking that impact anesthesia. Cigarettes contain nicotine which stimulates your heart and blood vessels to basically work harder. The nicotine stimulates your blood vessels to narrow which decreases the blood flow to your organs. This includes the coronary arteries leading to your heart muscle. The good news is that after a few hours of not smoking, the blood flow begins to improve.

Next, cigarettes contain carbon monoxide. I won’t get into the details, but many of you have carbon monoxide detection systems in your house. If these levels get too high, lots of bad things can happen. So you can imagine what effects chronic exposure to the carbon monoxide in cigarettes can do to your body.

Carbon monoxide is carried in the bloodstream and competes with oxygen. But carbon monoxide is a stronger competitor and the blood cells have a stronger affinity for it than oxygen. This leads to chronically decreased oxygen levels in the blood. This leads to decreased oxygen to the organs, an increase in red blood cells to compensate, which then thickens the blood, potentially leading to problems with blood flow and clotting. It is a vicious cycle. After about 12 hours of smoking cessation, carbon monoxide levels in the blood return to those of a non-smoker. Are you beginning to see why you should quit right away before your surgery and anesthesia?

The negative effects of smoking on the respiratory system have negative consequences for anesthesia as well. Smokers are prone to decreases in their oxygen levels, are more likely to have lung infections, are at higher risk for dangerous events such as bronchospasm and laryngospasm, just to name a few. Smoking damages the cilia in the lungs that help clear secretions. This can cause all sorts of problems during anesthesia when a breathing tube is placed.

There is evidence that different facets of the negative respiratory effects of smoking begin to improve after a few days. Many anesthesiologists also learned during their training that quitting smoking can actually increase respiratory consequences for up to 3 months after quitting. But there are no studies that prove this. The moral of the story is that quitting smoking now will allow your lungs to begin the healing process.

Another major consequence of smoking is its propensity to decrease wound healing. Blood carries healing substances in your body to wounds. But if there is not enough oxygen in the blood and the blood flow is decreased to the wound (both of which occur with smoking), a wound may not be able to heal properly. Few other things frustrate our surgeons more than a beautiful operation complicated by a poorly healing wound caused by smoking (or any other reason).

Because anesthesiologists take care of the heart and lungs during anesthesia, you can see how smoking negatively impacts anesthesia. It decreases blood flow to the organs that we are trying to protect during surgery, specifically the heart and lungs. Plus, it makes all aspects of the respiratory system more susceptible to complications due to the anesthesia medicines and the breathing tube. And it decreases healing of the wounds that are necessary for the operations.

Actually, the list goes on and on, but these are just highlights of the major effects on anesthesia.

When Should You Stop Smoking If You Are Having Surgery?

The answer is now. In just a few hours, some of the negative effects of nicotine on the cardiovascular system will begin to resolve. In twelve hours, carbon monoxide levels in the bloodstream start to return to pre-smoking values (this means more oxygen). In days, the lungs begin to heal when smoking is stopped.

When Can You Start Smoking After Surgery?

Obviously, there is no good time to re-start smoking after surgery. It is all dangerous for your body. The decreased oxygen levels, the decreased wound healing, the decreased blood flow, the increased thickness of your blood, the increased work load on the heart, etc are all bad.

I have met many patients that tell me they quit smoking after some major event landed them in the hospital. It might have been a heart attack, or cancer, or some other major health scare. This event “shakes them up”, causes them to re-evaluate their life, and prompts this change.

Why not use something more minor in comparison–this particular surgery–to prompt a change that will benefit you and your family the rest of your life. Use this time to make a decision to stop smoking!

Hopefully if you are having anesthesia for surgery and you are a smoker, you have read just a few of the negative effects of smoking on anesthesia. Honestly, smoking makes our job more difficult. This means that your body is at increased risk for harmful results specifically from being exposed to anesthesia (heart attacks, strokes, lung infections, decreased oxygen levels, etc).


Smokers are at a higher anesthetic risk for a multitude of bad things to happen while exposed to anesthesia. Local and regional anesthesia can be more safe in smokers in some cases, but sometimes, these anesthetic methods aren’t enough, and general anesthesia must be used. Therefore, smokers are always at higher risk despite the type of anesthesia used.

Are you a smoker? Are you about to have surgery? Did you quit smoking before your surgery? Have you started smoking again or were you able to quit?

Let us know about your experience with smoking and anesthesia by leaving a comment below. Thanks for visiting!

What General Anesthesia Side Effect have you experienced, if any?

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Category: Anesthesia Topics, Day of surgery, General Anesthesia

Comments (10)

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  1. Hi joe. Wonderful effort you are doing here. I am running a similar website on educating public about anesthesia . Can i use some of your posts on my site ? i will keep them as it is, will leave a link to original article and will give you all due credit .

    • David Draghinas says:

      You can use our material as long as you give credit and provide links.

      All the best to you.

      • Akash G U says:

        How long before an ACL knee surgery should one quit smoking for the anesthesia doze to be normal ?

        • David Draghinas says:

          The best thing someone can do for themselves is to quit as quickly as possible.

          This not only benefits the person’s overall health, but can help decrease the chances of respiratory complications during surgery, improve wound healing, help decrease the chances of infection, etc

          Dr Dave

  2. dr dilip paranjape says:

    this is dr dilip paranjape, a practicing anesthesiologist for last 35yrs after my MD.the info is very useful not only to patients but people like me

  3. Anita Adams says:

    Having surgery
    Still smoked
    How many hours before should u stop smoming and if u are under for 8 hrs wit anesthesia

    • David Draghinas says:

      I think it was mentioned in the article, but as soon as possible! And really resolve to stop smoking completely to improve overall health.

  4. smoker says:

    When Can You Start Smoking After Surgery?

    You dont even give a answer pretty usless to have in there, everyone that smokes allrady knows it is bad..

    and if they dont take it from them

    • David Draghinas says:

      The best thing you can do for your health is to stop smoking completely. If that’s not an option, many doctors will recommend not smoking for 2-3 weeks after surgery to minimize the chances of post operative complications.

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