Vaping and E-Cigarette Use in Children and Adolescents

Implications on Perioperative Care From the American Society of Anesthesiologists Committee on Pediatric Anesthesia, Society for Pediatric Anesthesia, and American Academy of Pediatrics Section on Anesthesiology and Pain Medicine

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; Sulpicio G. Soriano, MD


Anesth Analg. 2021;133(3):562-568. 

In This Article

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.