A scoping review of the impact of E-cigarettes on patients undergoing general anaesthesia

Title : A scoping review of the impact of E-cigarettes on patients undergoing general anaesthesia

Abstract:

Introduction: The use of electronic cigarettes has increased several folds worldwide in the last decade. While studies have documented the systemic harms of vaping, its specific impact on patients undergoing general anaesthesia remains unclear. This scoping review aims to assess the perioperative effects of e-cigarette use in patients undergoing elective surgery.

Methods: A scoping literature search of studies associating the use of e-cigarettes with patients undergoing surgery between 2003-2024 was conducted across Medline, Embase, and PubMed.  Studies were included if they provided association of the impact of e-cigarettes with general anaesthesia for patients undergoing elective procedures.  Studies in animals and those associated with the use of Tetrahydrocannabinol (THC) components were excluded. Methodological quality was described using the Critical Appraisal Skills Programme (CASP) tool. An inductive approach by 3 reviewers enabled identification of key concepts. Collaboration with a senior reviewer then generated higher-order interpretations.

Results: Amongst the 1075 studies identified, 24 studies were included. Majority of published work were literature reviews, with no prospective observational studies assessing the direct impact of the use of e-cigarettes with induction of general anaesthesia in elective surgery patients. The impact of vaping on the respiratory system such as airway hyperreactivity, risk of bronchospasm, and  E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) were mentioned in 18 papers. 7 papers identified the impact of vaping on the cardiovascular system, showing that it caused tachycardia, elevated blood pressure, increased cardiac output, and arrhythmias. 6 papers identified that the use of e-cigarettes was associated with delayed post-operative wound healing. 10 papers recognised that high quality studies are required to inform recommendations for the association of e-cigarettes with anaesthetic performance.

Conclusion: E-cigarettes may be associated with respiratory, cardiovascular, and systemic risks in patients undergoing general anaesthesia for elective surgery. However, the lack of high-quality studies limits the formation of definitive conclusions. Further research is urgently required to inform perioperative risk assessment, optimise anaesthetic management, and improve postoperative outcomes.

Key words: E-cigarettes, General anaesthesia, Perioperative outcomes

Biography:

Anouksha Pattar is a medical student at Imperial College London with a developing research interest in respiratory pathology and peri-operative medicine. Her academic work focuses on the respiratory implications of emerging health behaviours, particularly the use of electronic cigarettes. She is a contributing author to the scoping review examining the impact of vaping on patients undergoing general anaesthesia, exploring physiological effects, peri-operative risk, and implications for surgical and anaesthetic practice. She is keen to pursue an academic clinical career and is motivated by research that informs evidence-based peri-operative care and improves patient safety.