Smoking as a risk factor for intraoperative hypoxemia during one lung ventilation

Abstract

Smoking is associated with many intra and postoperative events, especially respiratory complications. Hypoxemia and airway damage are found to aggravate any pre-existing respiratory pathology among smokers. One lung ventilation (OLV) carries a 4-10 % risk of development of hypoxia. The purpose of this study was to predict the incidence of hypoxemia for smokers during OLV for patients undergoing video-assisted thoracoscopic surgery (VATS). Sixty patients undergoing VATS using OLV by double lumen tube were included in this pilot cross-sectional study. These patients were divided into 2 groups, group S which included 30 heavy smoker patients (smoking more than 20 cigarettes per day for more than 20 years) and group NS which included 30 non-smoker patients. Intra and postoperative arterial oxygen tension (PaO(2)), arterial carbon dioxide tension (PaCO(2)), and intraoperative peak airway pressure were compared between the 2 groups. PaO(2) was significantly higher in the non-smoker group than in the smoker group, both at the start and end of OLV. It was 173 ± 68 mmHg for NS compared with 74 ± 10.8 mmHg for S at the start of OLV; at the end of OLV it was 410 ± 78 mmHg for the former and 360 ± 72 mmHg for the latter (P < 0.05). From this study it can be concluded that for heavy smoker patients there was a significant reduction in arterial oxygen tension (PaO(2)) in comparison with non-smokers. However, hypoxemia reported for both groups was comparable.