Vaping and E-Cigarette Use in Children and Adolescents

Parallels Between E-cigarettes and Smoking Tobacco

Studies have shown that cigarette smoking has been implicated as a risk factor for postoperative complications in many different surgical subspecialties. Patients who smoke and undergo surgery have longer hospital stays, a higher risk of readmission, a higher rate of being admitted to an intensive care unit, and an increased risk of in-hospital mortality in comparison to nonsmoking patients.^[44–47] Longer periods of smoking cessation appear to be more effective in reducing the incidence/risk of postoperative complications. A systematic review of 25 studies on the optimal timing of smoking cessation concluded that at least 4 weeks of abstinence from smoking reduced respiratory complications, and abstinence of at least 3–4 weeks reduced wound healing complications.^[48] A retrospective review of ambulatory surgeries demonstrated that smokers may be at a greater risk of postoperative complications, such as delayed wound healing, pulmonary complications, and mortality than nonsmokers.^[49]

Smoking and vaping appear to be equally detrimental to wound healing and to be associated with a statistically significant increase in flap necrosis compared with the unexposed group. The results suggest that vaping should not be seen as a better alternative to cigarette smoking in the context of wound healing.^[50]

E-cigarettes may have just as much of a detrimental effect on tissue oxygenation as traditional cigarettes. Thermal imaging has demonstrated that the use of ENDS reduced cutaneous blood flow in the peripheral circulation in humans.^[51] Despite the normal pulmonary function tests, asymptomatic patients with a daily use of e-cigarettes for at least 1 year had a significant ventilation–perfusion mismatching that worsen immediately after vaping.^[52] Studies suggest that subclinical alterations in the lung function in asymptomatic patients who routinely use e-cigarettes are usually not detected by routine spirometry.^[53] It is, therefore, not practical to perform preoperative pulmonary function tests in asymptomatic vapers.

Authors and Disclosures

Deborah A. Rusy, MD, MBA, FASA*, Anita Honkanen, MD†, Mary F. Landrigan-Ossar, MD, PhD, FASA, FAAP‡, Debnath Chatterjee, MD, FAAP, FASA§, Lawrence I. Schwartz, MD||, Kirk Lalwani, MBBS, FRCA, MCR¶, Jennifer R. Dollar, MD#, Randall Clark, MD, FASA||, Christina D. Diaz, MD, FASA, FAAP**, Nina Deutsch, MD††, David O. Warner, MD‡‡ and Sulpicio G. Soriano, MD‡

*Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; †Department of Anesthesia, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, California; ‡Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; §Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; ||Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado; ¶Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon; #Pediatric Anesthesia Associates, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama; **Department of Anesthesiology, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin; ††Department of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington School of Medicine and Health Sciences, Washington, DC; and ‡‡Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota.

Address correspondence to
Deborah A. Rusy, MD, MBA, FASA, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, B6/319 CSC, 600 Highland Ave, Madison, WI 53792. Address e-mail to darusy@wisc.edu.

The authors declare no conflicts of interest.

Disclosures
Name: Deborah A. Rusy, MD, MBA, FASA.
Contribution: This author helped research, write, and submit the manuscript.
Name: Anita Honkanen, MD.
Contribution: This author helped research and write the manuscript.
Name: Mary F. Landrigan-Ossar, MD, PhD, FASA, FAAP.
Contribution: This author helped research and write the manuscript.
Name: Debnath Chatterjee, MD, FAAP, FASA.
Contribution: This author helped research and write the manuscript.
Name: Lawrence I. Schwartz, MD.
Contribution: This author helped research and write the manuscript.
Name: Kirk Lalwani, MBBS, FRCA, MCR.
Contribution: This author helped research and write the manuscript.
Name: Jennifer R. Dollar, MD.
Contribution: This author helped research and write the manuscript.
Name: Randall Clark, MD, FASA.
Contribution: This author helped research and write the manuscript.
Name: Christina D. Diaz, MD, FASA, FAAP.
Contribution: This author helped research and write the manuscript.
Name: Nina Deutsch, MD.
Contribution: This author helped research and write the manuscript.
Name: David O. Warner, MD.
Contribution: This author helped research and write the manuscript.
Name: Sulpicio G. Soriano, MD.
Contribution: This author helped research, write, and submit the manuscript.
This manuscript was handled by: James A. DiNardo, MD, FAAP.