Should smokers be refused surgery?
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Elective Surgical Procedures↗
Biomedical subjects
Matthew J Peters
Publications and source records attributed to Matthew J Peters.
Oxygen supplementation for chronic obstructive pulmonary disease patients during air travel.
PURPOSE OF REVIEW: By 2008 it is projected that over two billion people will be travelling by commercial aircraft each year. With an ageing population and treatment improvements, many of these travellers will have lung disease, particularly chronic obstructive pulmonary disease. Current guidelines as to whether a patient requires supplemental oxygen during the flight are based on limited research evidence. Awareness of the increased risk has resulted in recent scientific interest in this area. RECENT FINDINGS: Studies have demonstrated a lack of consistency in international guideline recommendations when performing assessments within the respiratory laboratory. This has led to more specific analysis of patients, including in-flight assessments, the inclusion of exercise stress and more interest in actual cabin pressure conditions. SUMMARY: Commercial air travel is generally safe for patients with chronic obstructive pulmonary disease when their disease is stable. All current guidelines reflect the considerable uncertainty in relation to the clinical circumstances when oxygen prescription during flight is essential. Currently planned flight outcome studies will provide more precise risk quantification.
Aircraft↗
Normobaric hypoxia inhalation test vs. response to airline flight in healthy passengers.
INTRODUCTION: There is little data available to determine the normal response to normobaric hypoxia inhalation testing (NHIT) and air travel. Quantifying a healthy response may assist in the evaluation of passengers considered at risk for air travel. The aims of this study were: (1) to quantify the degree of desaturation in healthy subjects during a NHIT and air travel; and (2) assess the validity of the NHIT when compared with actual in-flight responses. METHODS: There were 15 healthy adults (age 23-57; 10 women) who volunteered for this study. Preflight tests included lung function, arterial blood gas, pulse oximetry (SpO2), and NHIT (inspired oxygen 15%). SpO2 and cabin pressure were measured continuously on each subject during a commercial air flight (mean cabin altitude 2178 m; range 1719-2426 m). In-flight oxygenation was compared with the preflight NHIT. RESULTS: Lung function testing results were normal. There was significant desaturation (SpO2) during the NHIT (pre: 98 +/- 2%; post: 92 +/- 2%) and at cruising altitude (pre: 97 +/- 1%; cruise: 92 +/- 2%). There was no difference between the final NHIT SpO2 and the mean in-flight SpO2. There was a significant difference between the lowest in-flight SpO2 (88 +/- 2%) vs. the lowest NHIT SpO2, (90 +/- 2%). DISCUSSION: Oxygen saturation decreases significantly during air travel in normal individuals. In this group of healthy passengers the NHIT approximates some, but not all, aspects of in-flight oxygenation. These results can be used to describe a normal response to the NHIT and air-travel.
Adult↗
Smoking cessation and elective surgery: the cleanest cut.
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Contraindications↗
The pharmacotherapy of smoking cessation.
1. The great majority of smokers are chronically dependent on tobacco. This dependence arises from the rituals and sensory associations of smoking that are reinforced, within seconds, by a rapid burst of nicotine from the cigarette. 2. All forms of nicotine replacement therapy (NRT) -- gum, patches and inhaler -- and bupropion are safe and effective for increasing smoking cessation rates in the short and long terms. 3. Other than those who are minimally dependent, all patients willing to quit should be offered one of these therapies unless contraindications exist. The effectiveness of drug treatments is multiplied when associated with effective counselling or behavioural treatments. 4. While NRT is not recommended during pregnancy or in patients with cardiac disease, if the alternative is smoking NRT is almost certainly safe. 5. Combination NRT (more than one therapy) may be indicated in patients who have failed monotherapy in association with withdrawal symptoms. 6. There are some specific contraindications to the use of bupropion. Its subsidised availability should not influence prescribers to ignore these.
Antidepressive Agents, Second-Generation↗