The hemodynamic and hematologic effects of cigarette smoking versus a nicotine patch

Cold-induced vasodilation in abstinent smokers with and without a 12-hour nicotine patch

This study was designed to identify the effects of a 12-h nicotine patch administration on cold induced vasodilation (CIVD) in healthy young chronic smokers following 16 h of abstinence from smoking. Two laser Doppler probes and temperature thermocouples were placed on the dorsal part of the distal phalanx of the middle and ring fingers of 7 smokers (>12 cigarettes/day). Following 16 h of abstinence from smoking, smokers were tested with and without administration of a 21 mg transdermal nicotine patch (NicoDerm^® ). Each participant's right hand was immersed in cold (~5°C) water for 40 min. Cutaneous vascular conductance (CVC) was calculated from non-invasive arterial finger blood pressure and skin blood flow and expressed as a percentage of peak CVC observed during hand skin heating to 44°C. For comparison purposes, the CIVD response of a non-smoking cohort without nicotine patch (n = 10) was also examined. Baseline CVC was similar in smokers and non-smokers (27.8 ± 12.6 CVC % peak). The initial vasoconstriction during cold-water immersion decreased skin blood flow to 4.0 ± 3.9 CVC % peak in both smokers and non-smokers. The onset of CIVD in smokers (4.5 ± 1.5 min) was delayed compared to non-smoker (3.3 ± 0.8 min, p < .05). The area under the CVC %peak-time curve during cold-water immersion averaged 1250 ± 388 CVC %peak · min in non-smokers which was larger (p < .05) than smokers with or without nicotine (789 ± 542 and 862 ± 517 CVC %peak · min, respectively). Chronic smoking impaired the CIVD response to cold-water immersion of the hand; however, the impaired CIVD response in 16 h of abstinence from smoking was not influenced by application of a 21 mg transdermal nicotine patch.

Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry

Proximal femur fractures represent a major healthcare problem in the aging society. High rates of post-operative infections are linked to risk factors that seem to affect local microcirculation. Patterns and time courses of alterations in microcirculation have, however, not been previously investigated. The aim of this prospective cohort study was to evaluate perioperative changes in microcirculation after trochanteric femur fractures using non-invasive laser-Doppler spectrophotometry to analyze how oxygen saturation (SO₂), hemoglobin content (Hb) and blood flow changed before and after surgery, and how these parameters were altered by implant type, gender, smoking, diabetes and age. Measurements were separately recorded for nine locations around the greater trochanter in 2, 8, and 15 mm depths, before surgery and 8, 24, 48 h, 4, 7, and 12 days after surgery in 48 patients. Three implants were compared: Dynamic Hip Screw, Gamma3 Nail, and Percutaneous Compression Plate. Surgery resulted in significant differences between the healthy and injured leg in SO₂, Hb and flow. Each parameter showed comparable values for both legs prior to surgery. Significantly higher values in SO₂ and flow were registered in women compared to men before and after surgery. Smoking caused significant increases in SO₂, Hb, and flow only in the superficial layer of the skin after surgery. Diabetes decreased blood flow at 2 and 8 mm depth and increased SO₂ at 8 and 15 mm depth after surgery. Age revealed a significant negative correlation with flow. The ability to increase the flow rate after surgery decreased with age. Comparison of implants indicated the minimally invasive implant PCCP altered microcirculation less than the DHS or the Gamma3 nail. Overall, the proximal femur fracture alone did not alter local skin microcirculation significantly in a way comparable to the effect caused by surgery. In conclusion, microcirculation after proximal femur fractures is highly affected by surgery, gender, smoking, diabetes, age and implant in ways specified in this study.

The Effect of Electronic Cigarettes on Hand Microcirculation

PURPOSE

Smoking conventional cigarettes reduces peripheral microcirculation leading to worse outcomes after hand surgery. Patients are increasingly using electronic cigarettes (eCigarettes); however, there is no published research investigating the effects of eCigarettes on hand microcirculation.

METHODS

Fifteen healthy subjects with a median age of 26 years were recruited: 7 smokers and 8 nonsmokers. A noninvasive O₂C laser Doppler probe measured a baseline control reading at deep (7-mm) and superficial (3-mm) levels. Participants commenced a 5-minute smoking protocol of nonnicotine (0-mg) eCigarettes with continuous microcirculation measurements during smoking and for 20 minutes afterward. This was repeated with nicotine (24-mg) eCigarettes. Readings were averaged over 5-minute periods and standardized as a percentage of baseline. A linear mixed-effects model with an unstructured covariance structure was used to analyze the data.

RESULTS

Smokers had a statistically significant reduction in hand microcirculation during and up to 20 minutes after smoking a 24-mg eCigarette. There was a maximum reduction of 77% in superficial flow and 29% in deep flow. After smoking a 0-mg eCigarette, smokers demonstrated an increase in superficial flow of up to 70% with no change in deep flow. Nonsmokers had no statistically significant change in superficial or deep flow after smoking either eCigarette.

CONCLUSIONS

A 24-mg eCigarette significantly reduced smokers' hand microcirculation during and after smoking. Microcirculation increased in smokers after inhalation of a 0-mg eCigarette.

CLINICAL RELEVANCE

We advise smokers undergoing hand surgery to avoid high-dose eCigarettes and, if necessary, to use 0-mg eCigarettes as an alternative.

Safety and Efficacy of Nicotine Replacement Therapy in the Perioperative Period: A Narrative Review

Patients who smoke cigarettes are at increased risk for development of complications both during and after surgical procedures, including respiratory, cardiac, and healing-related complications. Abstinence from smoking can considerably reduce these risks. Pharmacotherapy, including nicotine replacement therapy (NRT), is an important component of efficacious tobacco use interventions. However, the use of NRT in the perioperative period is controversial. In this narrative review, we discuss the current evidence for the efficacy and safety of NRT in patients scheduled for surgical procedures, with emphasis on evidence from human studies. We performed a literature search for articles published from January 1, 1990, through May 1, 2015, in the PubMed online database using various permutations of the Medical Subject Headings terms surgery; surgical procedures, operative; nicotine; and smoking cessation. Studies were selected for inclusion according to their relevance to the preclinical and clinical evidence pertaining to how NRT affects surgical outcome and long-term rates of abstinence from tobacco. There is strong evidence that NRT enhances the efficacy of tobacco use interventions. Some preclinical studies suggest that nicotine in high doses that exceed those produced by NRT decreases the viability of skin flaps. Although the available data are limited, there is no evidence from human studies that NRT increases the risk of healing-related or cardiovascular complications. Individual clinical trials of tobacco use interventions that include NRT have revealed either no effect or a reduction in complication rates. Therefore, given the benefits of smoking abstinence to both perioperative outcomes and long-term health and the efficacy of NRT in achieving and maintaining abstinence, any policies that prohibit the use of NRT in surgical patients should be reexamined.

Brief smoking cessation intervention in relation to breast cancer surgery: a randomized controlled trial

BACKGROUND

Smokers are more prone to develop postoperative complications. Smoking cessation intervention beginning 4-8 weeks prior to surgery improves the postoperative outcome. Cancer patients, however, often undergo surgery less than 4 weeks after diagnosis. The primary objective of this study was therefore to examine if a brief smoking cessation intervention shortly before breast cancer surgery would influence postoperative complications and smoking cessation.

METHODS

A randomized controlled multicentre trial with blinded outcome assessment conducted at 3 hospitals in Denmark. One hundred and thirty patients were randomly assigned to brief smoking intervention (n = 65) or standard care (n = 65). The intervention followed the principles of motivational interviewing and included personalized nicotine replacement therapy aimed at supporting smoking cessation from 2 days before to 10 days after surgery.

RESULTS

The overall postoperative complication rate (including seroma requiring aspiration) was 61% in both groups risk ratio (RR) 1.00 (95% CI 0.75-1.33). The wound complication rate was 44% versus 45%. The effect on perioperative smoking cessation was modest, 28% intervention versus 11% control group patients, RR 2.49 (95% CI 1.10-5.60). There was no effect on smoking cessation at 12 months, 13% versus 9%.

CONCLUSIONS

Brief smoking intervention administered shortly before breast cancer surgery modestly increased self-reported perioperative smoking cessation without having any clinical impact on postoperative complications. The study adds to the body of evidence indicating that brief intervention has no clinical importance for surgical patients in regard to postoperative morbidity. Future studies should be designed to determine the optimal time of smoking cessation before surgery.

The effects of nicotine on the metabolic and hormonal responses during acute cold exposure

OBJECTIVE

To examine the effects of nicotine on the metabolic and hormonal responses during acute cold exposure.

METHODS

Participants in this study included 6 men and 5 women between the ages of 19 and 25 years. Each subject performed 2 cold-air trials (CATs) consisting of a 30-minute baseline (BASE) period and a 120-minute exposure to 10 degree C air. One CAT was performed after a nicotine (NIC) dosing using a 21-mg transdermal patch, whereas the other CAT was performed after a placebo (PL) treatment. Blood samples for metabolic and hormonal measurements were obtained at the end of BASE and immediately after the cold exposure.

RESULTS

When examining the sexes separately, there was no difference in norepinephrine between PL and NIC (P = .066). There was also no difference in epinephrine between PL and NIC in either sex (P = .634). From BASE to 120 minutes of the CAT, there was a significant decrease in cortisol (P = .036), but this response was similar between the 2 treatments (P = .077). Glucose and glycerol concentrations were not different between the PL and NIC treatments. At BASE, nonesterified fatty acid (NEFA) concentration was lower during PL compared with NIC (P = .021); however, at 120 minutes of the CAT, NEFA was greater during PL compared with NIC (P = .035).

CONCLUSIONS

During 120 minutes of cold exposure, NIC resulted in alterations in the responses in NEFA, whereas the other blood measurements were not significantly different between the 2 groups.

Nicotine replacement therapy-associated syndrome of inappropriate antidiuretic hormone

Nicotine has been documented to regulate the release of plasma arginine vasopressin (AVP). The literature is inconclusive about the effects of nicotine replacement therapy on AVP release, although cigarette smoking has been shown to increase the release of AVP. No clinical case reports have documented the possible association between nicotine replacement and hyponatremia through AVP release. We report a case of a 39-year-old man who experienced syndrome of inappropriate antidiuretic hormone while on nicotine patch therapy. We theorize that the constant serum concentration of nicotine levels provided through the patch may cause hyponatremia through the continuous stimulation of vasopressin.

Short-term pre-operative smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomized clinical trial

BACKGROUND

Smokers have a higher risk of complicated tissue and wound healing after surgery than nonsmokers. We tested the hypothesis that short-term pre-operative cessation of smoking in colorectal surgery decreases the incidence of postoperative tissue and wound complications.

METHODS

From February 1998 to March 2001, 60 patients, who smoked daily, undergoing colorectal resection were randomly assigned 2-3 weeks before scheduled surgery to either abstinence from smoking, counselling and nicotine replacement therapy or maintenance of daily smoking habits. Postoperative tissue and wound complications necessitating surgical or medical treatment were evaluated at discharge and 30 days after surgery by blinded outcome assessment.

RESULTS

In the pre-operative period of 15 days (8-24) (median, interquartile range (IQR)), 89% of the patients in the intervention group vs. 13% in the control group abstained from smoking or reduced by more than half (P < 0.05). In the postoperative period of 11 days (10-13), the corresponding figures were 92% and 50%, respectively (P < 0.05). Postoperative tissue and wound complications occurred in 33% (9 of 27) of the patients in the intervention group compared to 27% (8 of 30) in the control group (NS). Likewise, no difference in overall postoperative complication rate was found between the groups.

CONCLUSION

Short-term cessation of smoking does not reduce the risk of complicated tissue and wound healing or other complications in colorectal surgery.

Effects of cigarette smoking or nicotine replacement on cardiovascular risk factors and parameters of haemorheology

OBJECTIVES

Cigarette smoking causes cardiovascular (CV) disease, but the relative roles of nicotine and other components of tobacco smoke remain unclear. We investigated the effect of stopping smoking, by using nicotine replacement therapy (NRT), on haemorheology parameters.

DESIGN

Open, parallel-group trial (intervention group and control smokers).

SETTING

Clinic within university department of pharmacology.

SUBJECTS

One hundred and ninety-seven males, aged 25-45 years, smoking >20 cigarettes per day.

INTERVENTIONS

One hundred and sixty-four subjects were instructed to stop smoking and received NRT for 12 weeks and 33 acted as controls. After 12 weeks, NRT was discontinued, and all subjects were followed-up at 26 weeks. At the end of the study, the NRT group was divided into abstainers (self-reported, verified by exhaled carbon monoxide <10 ppm) and relapsers, who were unable to remain abstinent.

MAIN OUTCOME MEASURES

Plasma viscosity, fibrinogen, erythrocyte deformability, reactive capillary blood flow, transcutaneous partial oxygen tension (tcpO2) and haematocrit, assessed at 4, 8, 12, and 26 weeks. Results. After 6 months, plasma fibrinogen (9.95 vs. 8.24 micromol x L(-1) at baseline; P < 0.003), reactive capillary flow (t-pmax: 9.3 vs. 11.2 s at baseline; P < 0.005), and tcpO2 (50.4 vs. 34.9 mmHg at baseline; P < 0.0001) were significantly improved in abstainers, but changes in plasma viscosity and erythrocyte deformability were inconclusive. Other CV risk factors, such as haematocrit and white blood cell count, decreased to a greater extent in abstainers than in relapsers. Expired carbon monoxide concentrations reflected the changes in smoking and decreased in abstainers from 30.4 ppm at baseline to 4.2 ppm; P < 0.0001). Conclusions. Smoking cessation improved CV parameters, and use of nicotine medications did not negate these improvements.

Partial necrosis of an amputated penis following replantation in a heavy smoker: a case report

A case of penile amputation in a heavy smoker who was treated by microsurgical replantation is presented. The penis was cut by a kitchen knife and the ischaemia time until revascularisation was 3 hours. Following successful microneurovascular repair the penis survived. However, a 3 cm portion of the ventral segment, including the corresponding urethral segment, sloughed. The adverse effects of nicotine on vascular anastomotic network in heavy smokers are well known and may be the cause of the partial necrosis in this case.

The effect of transdermal nicotine on digital perfusion in reformed habitual smokers

The effects of transdermal nicotine-assisted smoking cessation on digital perfusion and health-related quality of life were assessed in 10 chronic smokers. Components of digital blood flow were evaluated by digital temperature and laser Doppler fluxmetry before, during, and after a standardized cold challenge. Nutritional flow was measured by vital capillaroscopy; a quantitative perfusion profile was obtained by laser Doppler perfusion imaging. A battery of validated measures were used to evaluate health-related quality of life. The microvascular response of smokers was evaluated before smoking cessation and at 2 and 7 days after smoking cessation and was compared with the response of nonsmoking controls. Results demonstrated that a (1) cutaneous microvascular perfusion was lower in smokers than nonsmokers, (2) the acute administration of transdermal nicotine did not decrease cutaneous perfusion, (3) smoking cessation and transdermal nicotine normalized digital microvascular perfusion by 7 days, and (4) transdermal nicotine and smoking cessation did not negatively impact health-related quality of life.

Transdermal nicotine inhibits interleukin 2 synthesis by mononuclear cells derived from healthy volunteers

BACKGROUND

Smoking has either a beneficial or harmful effect on the course and recurrence of ulcerative colitis (UC) and Crohn's disease respectively. Transdermal application of nicotine had similar effects in UC and therefore was considered to be an effective basic drug that could be further developed in the search for new compounds in the treatment of acute exacerbations of corticosteroid-resistant UC. To clarify the hypothesis that nicotine exerts its anti-inflammatory effect in UC through selective inhibition of T-cell-derived cytokine synthesis, we studied in vivo effects of nicotine on cytokine production by human non-adherent mononuclear cells isolated from peripheral blood in a randomized, double-blind, placebo-controlled trial.

METHODS

Healthy non-smoking volunteers applied for 2 weeks of nicotine patches (n = 12) with incremental doses of nicotine during the first week to achieve a maintenance dose of 15 mg per day, or placebo (n = 12). Blood was obtained before treatment and 1, 2, 3 and 6 weeks after the start of treatment. Cells were cultured in the absence or presence of phytohaemagglutinin for 48 h, and total amounts of interleukin 2 (IL-2), IL-4, IL-10, IL-13, interferon gamma (IFN-gamma) and tumour necrosis factor alpha (TNF-alpha) were measured.

RESULTS

Transdermal nicotine caused a significant inhibition of IL-2 after 2 weeks' treatment compared with the placebo group. In addition, a diminished production of IL-10 and TNF-alpha in comparison with day 0 was observed.

CONCLUSION

The beneficial effect of transdermal nicotine in ulcerative colitis may be mediated by a selective inhibition of the IL-2 production by mucosal mononuclear cells, which could result in diminished cell proliferation and consequently a reduction in the inflammatory process.