SMF ANESTESIOLOGI & TERAPI INTENSIF RSUD dr.

DORIS SYLVANUS

Perubahan Hemodinamik dan Saturasi Oksigen saat Anestesi Umum Pada

Perokok dan Bukan Perokok
(Haemodynamic Changes and Oxygen Saturation during General Anaesthesia in smokers and non
smokers)

Indian Journal of Clinical Anaesthesia,July-September, 2019;6(3):395-400

Meenakshi Agarwal, Suresh Singh, Satish Kumar,Shahba Ahmad, Santosh Kr. Sharma
(Ex-resident, Associate Professor, Proffesor.Assistant Professor,Dept of Anaesthesia, B.R.D Medical College, Gorakphur, Uttar, Prdesh India)

Pembimbing :
dr. Abdul Samad Amin, Sp.An
OLEH :
D I TA AY U P E RT I W I
FA B 11 8 0 6 5
 ABSTRAK

Physiological Perioperative and Research

Change in
Body Post Operative ? aim

Subjek  50 Pasien 37 lk dan 13 Recorded : Detail History,

Pr berusia 18-60 tahun dg ASA physical exam, BGA, partial
grade I dan II yang dijadwalkan u/ pressure oxygen pre and post Statistical analysis
Operasi Elektif . Dibagi dalam 3 operative T-test and Mann –
grup (Non Smoker, Smoker, Observe : Haemodynamic during Whitney test.
Smoker and Tobacco Chewers) GA
 Pendahuluan

 Rokok berkontribusi sebesar 20% dari kematian di negara berkembang

 4700 bahan kimia & 43 karsinogen  pathophysiological effect.
Smoking Cardiac & Pulmonary Complication, Impairs Tissue Healing,
Associated more infection and other problem at the surgical site.
Nicotine  increase Intracellular calcium during ischemia  exacerbate
myocardial cell damage ( In Smoker  Plasma concentration of nicotine
reaches 15-50mg /ml with half time 30-60minute)acts through
sympathoadrenergic system  increased heart rate
Materials and Methods

Patient of either sex range 18-60 years of ASA grade I & II

scheduled for elective procedure at Nehru Hospital
Recorded  Identity, smoking and tobacco chewing habits, if
smoker number of bidi or cigarettes cosumed/day, number of
years smoker was taken. General &Systemic examination. BGA
Analysis pre & post op day 1,2,3.
Excluded  Patient w/ known respiratory disease,recent URTI,
GERD, Hypertensive, receiving medication affecting lung
function
 ……Materials and Methods

Subject divided into 3 group :

Group I : Non-Smokers (20 Patient)
Group II : Smokers-Patient who smoke >10bidi or cigarette/day (20
Patient)
Group III : Smokers and Tobacco Chewers (10 Patient)
 Routine Monitoring  Pulse rate, SpO2 (during surgery)
 Monitored every 8hours for 3 post operative days  Pulse rate,
BP, MAP,Partial pressure of Oxygen.
Statistical Analysis

Analisis Statistik SPSS Version 16.0 software. w/ T-Test and

Mann-Whitney test. Level of significant 95%. P<0,05
 Result

Study included 50 patient  elective surgery divided in 3 Group

Haemodynamic variable were compared  Preoperative

(basal), Just after intubation, 5 min after intubation, 30 min after
intubation, before extubation, just after extubation,
postoperative day 1,2,&3.
….Result
 ….Result

Means Pulse Rate in Group II & III  Highly Significant Rise &
Most Highly Significant Rise
 ….Result

Means Systolic BP Group II & III  Highly Significant Rise &

Most Highly Significant Rise
 ….Result

Means Diastolic BP Group II & III  Highly Significant Rise &

Most Highly Significant Rise
 ….Result

Means Arterial Blood Pressure Group II & III  Highly

Significant Rise & Most Highly Significant Rise
 ….Result

Means Oxygen Saturation Group II & III  Highly Significant

Rise & Most Highly Significant Rise (After Extubation)
 Discussion

Component of cigarette smoke  Wide ranging effects of KV,

Respiratory, Immune Systems, Haemostasis, Drug Metabolism,
Patient Psychology

Mean Pulse Rate, Systolic BP, Diastolic BP, and mean arterial
pressure was increased in all group just after intubation &
extubation. Amplitude maximum in GROUP III
 ….Discussion

Similar w/ this  Laxton (1991) studied, haemodynamic changes in

response to tracheal intubation in 60 ASA I Women undergoing elective
Gynaecological surgery.

Similar w/ this  King et,al (1951) Reflex circulatory responses to ET in

46 Px who Received Various combinations of IV & Inhalation agents. In
All px Significant Rise of MPR, MSBP, MDBP,MAP. Just after intubation
and gradually returned to prelaryngoskop level within 5 min after
intubation  fatigue of reflex receptor.
 ….Discussion

After extubation highly significant fall in mean Oxygen

Saturation in Group II and reduction in Group III.

Similar w/ this  Dennis et,al (1994)studied effect of smoking on

induction anaesthesia on 120px undergoing elective surgery 
concluded reduction of SpO2 > adverse event during induction.
Perioperative smoking cessation effective to reduce postoperative
complication
 ….Discussion

In General Anesthesia  anesthesia interact with whole body, function of

central nervous system is depressed  Change the haemodynamic

ET Intubation artificial airway Pulmonary ventilation possible free

from upper airway obstruction. (in the other side, Increased airflow
resistant in tubular system)  Poiseulle Law.

• Longer Tube = Greater the resistance imposed.

• To Eliminate Participation of Upper Airways. Air inhaled to LRT
without conditioning.
 ….Discussion

In Smokers…
• Cigarette & Tobacco Poison  Irritate Tender tissue in respiratory
tract (Bronchiole, alveolar, damage lining of lung) Damage
Elastin Decrease lung ability to exchange air efficiency More
Potential to experience Hypoxia.
Cardiovascular Effect 
• Cigarette & Tobacco Poison  Increased intimal medial thickness,
inflammation, endothelial dysfuction Hypercoagulability, & platelet
activation  Increased BP Increase vascular stiffness
….Discussion
….Discussion
….Discussion
 Conclusion

• Most of smokers& tobacco chewers significant reduction

in preoperative bedside pulmonary function test decrease
in partial pressure of oxygen.
• These px required  oxygen inhalation postoperatively to
prevent hypoxia.
Thank You