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Anesthetists are generally familiar with the perioperative implications of patients' cigarette smoking. Electronic cigarettes are, however, a relatively newly popular phenomenon among adolescents and young adults. There is a generalized lack of knowledge among healthcare providers regarding the overall health effects of electronic cigarettes, which often are advertised as a harmless smoking-cessation tool. US health protection agencies have reported that electronic cigarettes contain cytotoxic compounds and harmful byproducts such as nicotine, heavy metals, propylene glycol, diacetyl, and other impurities. The current literature suggests that components of these devices (the liquid and heating element) produce chemicals that can cause acute and chronic multiorgan toxicities. On a cellular level, the pulmonary, cardiovascular, immunologic, and pharmacologic effects of electronic cigarettes are most noteworthy. The purpose of this article is to inform anesthesia providers regarding the pathophysiologic effects and anesthetic implications of electronic cigarette use.
Keywords: Anesthesia considerations, cytotoxic, electronic cigarettes, health effects, vaping.
Despite being advertised as an effective alternative to traditional cigarettes, electronic cigarettes (EC) contain nicotine and other harmful byproducts that may greatly increase the risk of complications during general anesthesia. A descriptive pilot study conducted at the Ohio State University used survey instruments to measure e-cigarette knowledge, perceptions, and awareness among healthcare providers (ie, physicians, practitioners, nurses, and respiratory therapists).1 The study researchers concluded that there is indeed a gap in knowledge and misperceptions regarding the utility and health effects of EC. This conclusion warrants further investigation and education regarding these new products among anesthesia providers.
Electronic cigarettes, also known as electronic nicotine delivery system, are devices that produce an aerosol, or vapor, by heating a liquid that contains a desired solvent such as nicotine.2 The primary components of EC are a plastic tube with an electronic heating element, a liquid cartridge, and a removable battery. The powered battery uses the heating element to vaporize the liquid into an aerosol, which the user (also known as vaper) then inhales2 (Figure). The liquid, the electrical characteristic of the heating element, and the temperature reached determine the composition of the aerosol that is generated. The primary ingredients found in the liquid e-cigarette cartridges include nicotine (0-24 mg), propylene glycol, and glycerin for flavoring.3 Other constituents of liquids and aerosols that are traceable in e-cigarettes include acetone,...