A Discussion about Modalities of Smoking Cessation in Perioperative Phase for Addicts: A Review Article

Cigarette smoking is a worldwide healthcare problem of modern age. It is a leading cause of death, mainly in male population. Excess deaths among smokers, as compared to non smokers, are chiefly due to tuberculosis and respiratory, cardiovascular or malignant diseases. Smoking significantly increases intraoperative and postoperative complications in a person undergoing surgical procedure. Smoking is menace to people and physicians and cessation of smoking is very much desirable, especially in persons undergoing operative intervention. Smoking cessation prior to the operation has been traditionally advised to be for 6 weeks but such an endeavour may have unwanted consequences because of withdrawal symptoms. Hence it is necessary that smoking cessation is achieved with minimal consequences so that the operative procedure can be conducted with minimal problems. Smoking cessation for a current user needs an active approach and provision of support for a cessation attempt. A combination of pharmacotherapy with behavioral interventions provides the best results. Available treatment modalities are nicotine replacement therapy and non-nicotine therapies such as bupropion, nortriptyline and varenicline. The most commonly used drugs are varenicline and bupropion. The focus of this article is on partial selective nicotine receptor agonist drug varenicline. By comparing different studies and researches worldwide, we showed in this article that varenicline provides the most sustaining and cost effective result. It also has less cardiovascular and respiratory side effects than nicotine replacement therapy and bupropion. The only limiting side effect may be psychiatric side effects including depression, self harm and suicidal tendencies, though they warrant further investigation and research.</p

Factors Affecting Pulmonary Artery Catheterisation in Patients Undergoing Coronary Artery Bypass Grafting: A Cross-sectional Study

Introduction: The Pulmonary Artery (PA) catheter continues to be used for monitoring haemodynamic parameters in the majority of patients undergoing Coronary Artery Bypass Grafting (CABG) surgeries, despite concerns raised regarding costeffectiveness and safety issues. Sometimes, placement takes longer or is difficult just by looking at the pressure waves. There are several factors that may influence the duration of Pulmonary Artery Catheter (PAC) insertion. Aim: To determine the factors affecting PAC in anaesthetised patients undergoing elective CABG. Materials and Methods: A single-centred, cross-sectional study was conducted in the Cardiothoracic and Vascular Surgery operation theartre at IPGME&R and SSKM Hospital, Kolkata, India including 138 patients aged 35-65 years of either sex undergoing elective CABG surgery in a tertiary care hospital in Eastern India. The attempt to perform successful first-time catheterisation or failure of the PAC done by a resident cardioanaesthesiologist was noted, as well as whether catheterisation was successfully done within a specified time or not. This time was obtained as the 75th percentile of the time taken for catheter placement for the first 30 cases catheterised in the first attempt. For ease of analysis, all first attempt successful cases were considered as Group A (n=125), and all first attempt failure cases as Group B (n=13). The study data on various parameters were recorded on a proforma and summarised as the mean and standard deviation for normally distributed numerical variables, median and interquartile range for skewed numerical variables, and counts and percentages for categorical variables. A p-value <0.05 was considered statistically significant. Results: A total of 138 patients were analysed during the entire study. There was a predominance of male patients (82.6%) with a male-to-female ratio of 114:24. The first attempt failure rate of successful PAC was 13 out of 138, i.e., 9.42% (95% confidence interval 4.55% to 14.29%). The cut-off time for the procedure as the 75th percentile of the first 30 successful cases is 269 seconds. The number of cases in which it was done within this time was 109 cases, i.e., 78.99%. There was a significant difference (p<0.05) in terms of body weight, body surface area, and neck length between the two groups. Conclusion: Increased body weight and increased body surface area are significant factors associated with difficult PAC placement. On the other hand, short neck length is a significant factor for taking more time in the placement of the catheter