The Anesthetic Implications for The Patient Who Vapes

Background: According to data from the National Center for Health Statistics and the Centers for Disease Control and Prevention (CDC), about 8.1 million adults and 2.55 million adolescents in the United States (US). use electronic cigarettes (ECs). With the number of vaping individuals in the US increasing and the damage done by ECs to the lungs being so hazardous, in 2020, the CDC was forced to declare an outbreak of Electronic Cigarette or Vaping Associated Lung Injury (EVALI). EC users, who consider themselves distinct from traditional cigarette smokers, identify as vapers. This may present challenges for anesthesia providers in assessing smoking status before surgery, potentially leading to complications during the perioperative period. This literature review examined the acute and chronic side effects of ECs and their impact on surgical patients under anesthesia. This literature review also offered recommendations for anesthesia providers managing patients who vape. Methods: For this quality improvement project, anesthesia providers at a large urban teaching hospital in south Florida received an educational intervention tool with evidence-based information. Anesthesia providers were educated on the negative side effects associated with the use of ECs for surgical patients and potential perioperative management techniques that can be utilized to avoid complications. A survey determined the knowledge of providers before and after the educational intervention. Outcomes were measured by evaluating the variations in the anesthesia providers’ knowledge of the negative side effects associated with electronic cigarettes and perioperative management techniques for this patient population, pre and post intervention. In order to generate reports, Qualtrics® software was used to create the surveys and analyze the data. Results: An educational intervention was designed and delivered via email to anesthesia providers at a large urban hospital in south Florida. The goal of this educational intervention was to improve their knowledge of the anesthetic implications for patients who vape. Pre- and post-test scores were compared and evaluated. Overall, there was an increase in participant knowledge following the educational intervention. Discussion: Data collected from the surveys showed that participant knowledge regarding the neurological, ocular, oropharyngeal, and cardiopulmonary effects from vaping and the anesthetic implications for each of these organ systems increased. The most significant increase in knowledge was regarding airway hyperresponsiveness and EC liquid flavorings. A small sample size and the time frame for responses were limitations of this project. Conclusion: Evidence-based research shows that patients who vape have an increased risk for complications during the perioperative period, especially when their social history is undisclosed. Results showed an increase in anesthesia provider knowledge regarding the importance of obtaining a thorough preoperative evaluation in patients who vape, the potential complications that can occur during the perioperative period, and the anesthetic implications that can allow for increased patient outcomes in spite of this social comorbidity. Continued research into vaping can lead to improvements in patient outcomes by standardizing preoperative evaluations and perioperative management techniques for patients who vape.