The Effects of Cigarette Smoking on Steroidal Muscular Relaxants and Antibiotics Used: A Prospective Cohort Study.

Na Liu,Minhuan Shen,Jing Shi,Qian Zhou,Feng Wang,Xiaohua Zou

doi:10.3389/fphar.2021.573832

Abstract

Background: The impact of cigarette smoking on perianesthesia management is not clear elucidated. This paper studies the impact of long-term cigarette smoking on the dose-response of rocuronium and vecuronium used under general anesthesia and the type of antibiotics used after surgery. Methods: We enrolled 240 participants from a teaching hospital in China in which finally enrolled in 221 participants. 106 participants have a history of long-term cigarette use and 115 participants without a history of smoking. All participants received general anesthesia for various surgeries, and rocuronium was used as the muscular relaxant. The primary outcome was the effective onset time of rocuronium after adjusting for its dose. The secondary outcomes included a recovery index and the time of muscle recovery changing from 25 to 75%. Results: There was no measurable difference in the muscle relaxant onset time, duration of effectiveness, 75% recovery, recovery index, dose of opiates, anesthetics during surgery, or complication rate between smokers or non-smokers. However, the results showed a significant difference in antibiotic use between smokers and non-smokers (chi-squared = 13.695, p < 0.001), and a significant difference in the type of antibiotics used (chi-squared = 21.465, p = 0.003). Smokers had a significantly higher rate of cefathiamidine use. Conclusion: Smoking cigarettes had no effect on muscle relaxants used under general anesthesia, but patients who had a history of smoking were more likely to receive antibiotics after surgery. Clinical Trial Registration: http://www.chictr.org.cn/index.aspx, identifier ChiCTR-OIC-16009157.

Highlights

The number of smokers has reached one billion globally, and China ranks first with over 300 million smokers
Five were excluded for unclear history of cigarette smoking; seven were excluded for unwillingness to participate in the study; and Impact of Smoking on Use of Muscle Relaxants, Antibiotics, Anesthetics and Opiates
Logistic regression confirmed the significant difference in antibiotic use (odds ratio (OR) 2.87, 95% confidence interval (CI) 1.58 to 5.32; p < 0.001) between smokers and non-smokers, and showed that smokers had a significantly higher rate of cefathiamidine use

Summary

Introduction

The number of smokers has reached one billion globally, and China ranks first with over 300 million smokers. A number of reviews show that cigarette smoking is associated with increased peri-operative complications (Beckers and Camu, 1991; Rodrigo, 2000). It increases the risk of hospital mortality by 20% and the risk of major postoperative complications by 40% (Ruppert et al, 2018). It works by competitively binding to nicotinic acetylcholine receptors on motor endplates. It is intermediate-acting, rapid-onset, and works without cardiovascular side effects. It was introduced in clinical settings as a potentially ideal muscle relaxant (Özcengiz, 2005). This paper studies the impact of long-term cigarette smoking on the doseresponse of rocuronium and vecuronium used under general anesthesia and the type of antibiotics used after surgery

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